Survival of a large cohort of HIV-infected tuberculosis patients in the era of highly active antiretroviral treatment
Abstract:OBJECTIVES: To determine the survival rate, predictive factors and causes of death in a cohort of human immunodeficiency virus (HIV) infected tuberculosis (TB) patients in the era of highly active antiretroviral treatment (HAART).
DESIGN: This retrospective cohort study included all HIV-infected TB patients reported in Barcelona between 1996 and 2006. A survival analysis was conducted based on the Kaplan-Meier estimator and Cox proportional hazards; hazard ratios (HRs) and their 95% confidence intervals (CIs) were calculated. Causes of death were classified using the International Classification of Diseases (ICD) 9 and ICD-10, and defined as acquired immune-deficiency syndrome (AIDS) related, non-AIDS-related or unknown.
RESULTS: Of the 792 patients included, 341 (43.1%) died. Survival at 10 years was 47.4% (95%CI 45.2–49.6). Poorer survival was observed in patients aged >30 years (HR 1.6, 95%CI 1.1–2.1), inner-city residents (HR 1.3, 95%CI 1.1–1.7), injecting drug users (HR 1.4, 95%CI 1.1–1.8), those with a non-cavitary radiological pattern (HR 1.5, 95%CI 1.0–2.2), those with <200 CD4/μl (HR 1.8, 95%CI 1.2–2.7) and those diagnosed with AIDS prior to their TB episode (HR 1.85, 95%CI 1.4–2.2). No differences were found for TB treatment (6 vs. 9 months) or for anti-tuberculosis drug resistance; 64.8% of the deaths were non-AIDS-related.
CONCLUSIONS: Poor survival was observed despite the availability of HAART, and non-AIDS-related mortality was high. Earlier HAART could help address AIDS and non-AIDS-related mortality.
Document Type: Regular Paper
Affiliations: 1: Epidemiology Service, Public Health Agency of Barcelona, Barcelona, Spain; Unidad Docente de Medicina Preventiva y Salud Pública H.Mar-UPF-ASPB, Barcelona, Spain 2: Epidemiology Service, Public Health Agency of Barcelona, Barcelona, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
Publication date: 2011-02-01
The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on tuberculosis and lung health world-wide.
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