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• Among 972 individuals with HIV, the prevalence of tuberculosis (TB) was 10% and the 2-year mortality was 4.0%. • After adjusting for confounders, TB status was not associated with increased mortality. • Mortality was associated with missed antiretroviral treatment, symptomatic HIV disease, and low CD4 count. • Among TB-positive individuals, only missed treatment for HIV and TB predicted mortality. • Systematic screening for TB in HIV is associated with limited mortality. Few studies have evaluated the mortality rate in individuals with HIV initiating antiretroviral therapy (ART), undergoing screening with combined or repeated rapid tests for tuberculosis (TB). All individuals with HIV starting ART, irrespective of the presence of TB-related symptoms, received two consecutive Xpert tests plus a rapid test for the detection of mycobacterial lipoarabinomannan in urine (LAM). Mortality was evaluated by Kaplan–Meier analysis using the log-rank test in univariate analyses and Cox regression models with time-dependent covariates in multivariate analyses. Among 972 individuals screened with combined tests, 98 (10.1%) tested positive for TB with Xpert, LAM, or both. At the end of the study, 780 (80.2%) had completed 2 years of follow-up, 39 (4.0%) had died, and 153 (15.7%) were lost to follow-up. In the multivariate analyses, the factors significantly associated with mortality were missed ART (hazard ratio (HR) 7.05, 95% confidence interval (CI) 2.33–21.35), symptomatic HIV disease (WHO-HIV stage >1) (HR 3.31, 95% CI 1.28–8.54), and low CD4 count (<200/mm3) (HR 2.72, 95% CI 1.21–6.13), with no significant effect of TB status. In the subgroup of the 98 TB-positive individuals, only missed ART (HR 4.12, 95% CI 1.03–16.46) and missed anti-TB treatment (HR 9.25, 95% CI 2.65–32.28) were significantly associated with mortality. A low mortality rate was observed among individuals with HIV undergoing systematic testing for TB at initiation of ART. After adjusting for confounders, mortality was significantly associated with missed ART, advanced disease, and missed anti-TB treatment. These findings reinforce the need to promote early diagnosis of HIV and the adoption of screening strategies for TB that prevent presentation with severe disease. [ABSTRACT FROM AUTHOR]

• Hypergammaglobulinemia is common in Malawian HIV-positive pregnant women. • Twenty-four months of antiretroviral therapy improved but did not normalize IgG anomalies. • The IgG2 isotype remained highly underrepresented. • The potential influence of immunoglobulin disorders should be considered when assessing the risk of infection in HIV-exposed infants. Hypergammaglobulinemia and anomalies in the IgG subclass distribution are common in HIV-infected individuals and persist even after many years of antiretroviral therapy (ART). The aim of this study was to investigate the IgG profile and dynamics in pregnant HIV-infected Malawian women in the Option B era. Thirty-seven treatment-naive women received ART from the third trimester of pregnancy to 6 months post delivery (end of the breastfeeding period). ART continuation (group C) or interruption (group I) was then decided on the basis of the CD4+ cell count at enrolment (>350 or ≤350/μl). Total IgG and IgG subclasses were determined in maternal serum using a nephelometric assay at baseline and at 6 and 24 months postpartum. At enrolment, 36/37 women had IgG levels >15 g/l and there was a predominance of the IgG1 isotype (more than 90%) in parallel with underrepresentation of IgG2 (5.0%). After 6 months of ART, both groups showed a significant median decrease in total IgG (−3.1 g/l in group I, −3.5 g/l in group C) and in IgG1 (−4.0 g/l and −3.6 g/l, respectively), but only a modest recovery in IgG2 levels (+0.16 in group I, +0.14 g/l in group C). At month 24, hypergammaglobulinemia was still present in 73.7% of women in group C, although a significant reduction was observed in total IgG level and in IgG1 and IgG3 subclasses (p < 0.0001 in all cases). IgG2 levels did not show any significant change. In group I at 24 months, total IgG and IgG subclasses had returned to levels comparable to those at baseline. The beneficial effects of 24 months of ART appear to be limited in the B-cell compartment, with an incomplete reduction of total IgG levels and no recovery of IgG2 depletion. A short ART period did not have significant effects on IgG abnormalities in women who interrupted treatment. [ABSTRACT FROM AUTHOR]