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Free Content Association between tuberculosis and HIV disease progression in a high tuberculosis prevalence area

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SETTING: Adult human immunodeficiency virus (HIV) clinics affiliated to the University of Cape Town, South Africa.

OBJECTIVE: To assess the impact of tuberculosis on HIV-1 disease progression in an area with high tuberculosis prevalence and minimal antiretroviral therapy use.

DESIGN: Prospective patient cohort study.

METHODS: Age, race, risk status, CD4+ T-lymphocyte count, history of AIDS, prophylactic co-trimoxazole and antiretroviral therapy were controlled for in a time-dependent Cox proportional hazards regression model.

RESULTS: Tuberculosis fulfilling the case definition developed in 158/609 patients in the 5-year observation period. Tuberculosis was associated with an increased risk of AIDS (adjusted risk ratio [RR] = 1.60, 95% confidence interval [CI] 1.08–2.41; P = 0.02) and death (adjusted RR = 2.16, 95%CI 1.29–3.59; P = 0.003). In a stratified analysis, the increased mortality associated with tuberculosis was observed only in patients with CD4+ T-lymphocyte count >200 cells/μl and in those without AIDS at baseline.

CONCLUSION: The onset of tuberculosis in HIV-infected patients is associated with an increased risk of AIDS and death. Although a causal link cannot be established in an observational study, our findings support the view that prolonged immune activation induced by tuberculosis leads to prolonged increased HIV replication and consequent accelerated disease progression.
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Keywords: AIDS; CD4+ T-lymphocyte; HIV infection prognosis; survival; tuberculosis

Document Type: Regular Paper

Affiliations: 1: Department of Public Health, University of Cape Town, Cape Town, South Africa 2: Department of Medicine, University of Cape Town, Cape Town, South Africa 3: Harvard Medical School, Boston, Massachusetts, USA

Publication date: March 1, 2001

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  • 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.

    Certain IJTLD articles are selected for translation into French, Spanish, Chinese or Russian. They are available on the Union website

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