Established on appropriate TB treatment, ART and cotrimoxazole, then bacterial infections emerge as the most important cause of death. We suspect that colonization with multi-drug resistant bacteria occurred in the referring general hospital, as antibiotic selection pressure in TB hospitals is likely to be low. High rates of urinary catheterization during the acute admission at the referring hospital, is a likely contributing risk factor to the urinary tract infections. Depressed monocyte responses may be one of the reasons why HIV-infected patients with advanced immunosuppression are at high risk of bacterial infections. Our study and a previous study from a hospitalized cohort in Cape Town, confirm that drugresistant bacteria which require the use of carbapenems and other costly antibiotics are causing HAI. These antibiotics are generally unavailable at district or secondary level hospitals in developing countries and there is therefore often a delay in treating these infections appropriately resulting in high mortality. Furthermore, because the risk of multi-drug resistance is high in HAIs, it is essential to culture clinical specimens prior to commencement of antibiotics. Our findings emphasize not only the need for appropriate antibiotics to be available, but for basic infection prevention control practices, most importantly effective hand disinfection, to be re-inforced and practiced to prevent secondary spread of infection. Reducing the number of days that patients have urinary catheters in situ, and wherever possible avoiding the need for indwelling intravenous catheters are also important interventions. Every attempt is made to limit duration of hospital stay. However, severity of illness and extremely poor social circumstances often preclude early discharge. Our study has several limitations. The follow-up period was limited to the first 3 months of ART, so events occurring in the latter half of TB therapy were not ascertained. The generalizability of our findings is limited by the fact that all participants in the study were evaluated by a specialist physician trained in infectious diseases at study visits, which could in part explain our relatively low mortality. There was no control group to ascertain outcome of patients who did not receive input from an Infectious Diseases specialist. Another factor limiting generalizability of our outcomes is that BCH is relatively well-resourced with access to radiology and laboratory services. It is unlikely that such good outcomes can be achieved in less well-resourced facilities, which would be found in the majority of TB hospitals in low- to middle-income countries. However, specialist input and access to diagnostic facilities allowed us to ascertain the frequency and type of complications occurring in sick HIV-TB inpatients starting ART. Another limitation is that not all patients developing sepsis had appropriate cultures sent, as transportation of specimens to the off-site microbiology laboratory occurs only once a day during weekdays. In addition the causes of death were ascertained by the attending infectious diseases specialist and no post-mortem studies were performed on the patients. For the analysis of predictors of mortality the sample size was to too small to allow for meaningful comparison AbMole Hexyl Chloroformate between groups. Our findings have important implications for service delivery and resource allocation at hospitals offering dedicated tuberculosis services.