HIV/AIDS – Research and Palliative Care 2012:4 159–168 HIV/AIDS – Research and Palliative Care Causes of mortality among tuberculosis and HIV co-infected patients in Chiang Rai, Northern

Background: The case fatality rate in patients with tuberculosis (TB) associated with human immunodeficiency virus (HIV) has been particularly high in Chiang Rai, Northern Thailand. It was almost 50 % before the introduction of antiretroviral therapy in the last decade, and was still at 28 % in 2008, despite expanding access to antiretroviral therapy. Reviewing the causes of death may lead to further understanding of the timeline and natural history of TB-HIV coinfection, and in so doing help to devise an effective prevention strategy in Chiang Rai. In this study, we aimed to investigate the distribution of confirmed causes of death in patients coinfected with TB and HIV in Chiang Rai, describe the causes of such deaths along the timeline of TB treatment, and identify predictors of each cause of death. Methods: In this retrospective study, we reviewed the causes of death for 331 patients who died of TB-HIV coinfection at Chiang Rai Prachanukroh Hospital from 2005 to 2008. Causes of death were confirmed by reviewing medical records, vital registration, and the TB register in the province, as well as obtaining reconfirmation by two experienced HIV physicians. Results: The confirmed causes of death were TB (39%), acquired immune deficiency syn-drome (AIDS)-related opportunistic infections other than TB (AOI) (29%), and other systemi