2.7 Prognosis

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TB is a severe and often deadly disease without treatment. After 5 years without treatment, the outcome of smear-positive pulmonary TB (PTB) in HIV-negative patients is as follows:

• 50-60% die (case fatality ratio for untreated TB)
• 20-25% are cured (spontaneous cure)
• 20-25% develop chronic smear-positive TB.

With adequate treatment, the case fatality ratio (CFR) in drug sensitive TB cases often falls to less than 2 to 3% under optimal conditions. Similar CFRs are seen with untreated EPTB and smear negative PTB, with an equivalent fall in CFR with adequate treatment. Untreated TB in HIV-infected patients (not on antiretroviral) is almost always fatal. Even on antiretroviral, the CFR is higher than in non-HIV infected patients