Impact of tuberculosis on the course of HIV-infected patients with a high initial CD4 lymphocyte count
MATERIAL AND METHODS: In an observational study of retrospective cohorts, the evolution of 28 HIV-infected patients with TB and a CD4 lymphocyte count >500 × 106 cells/l was compared with 56 HIV-infected patients without TB. Each case was paired with two controls by CD4 lymphocyte count (±50 × 106/l) and date of starting follow-up (±6 months). The progression of HIV infection was evaluated as: 1) immunological progression: time to CD4 lymphocyte count <200 × 106/l; 2) clinical progression: time to development of acquired immune-deficiency syndrome (AIDS), excluding TB; 3) survival; and 4) global disease progression: time to the first defined event in 1, 2 and/or 3. The times to these events were estimated using Kaplan Meier curves.
RESULTS: There were no significant differences between the cohorts for age, sex and risk group. Faster immunological impairment (RR 2.94; 95%CI 1.46–8.6; P < 0.01), greater progression to AIDS (RR 4.01; 95%CI 1.66–9.69; P < 0.01), lower survival (RR 3.89; 95%CI 1.53–9.87; P < 0.05) and higher global disease progression (RR 2.82; 95%CI 1.57–5.09; P < 0.01) were found in the cohort of TB patients. These associations were still significant after adjustment for CD4 lymphocyte counts.
CONCLUSION: The diagnosis of TB in HIV-infected patients with a high initial CD4 lymphocyte count (>500 × 10 6/L) was related to greater progression to AIDS and shorter survival.
Document Type: Regular Paper
Publication date: 2004-04-01
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