A prospective study of tuberculosis and HIV disease progression.
OBJECTIVE
To determine whether active tuberculosis alters the rate of progression of HIV infection in dually infected patients.


METHODS
HIV-seropositive patients at two Bronx, New York hospitals with tuberculosis confirmed by culture from July 1992 to February 1995, who survived the initial hospitalization for tuberculosis, were matched on gender, age, CD4+ percentage, and calendar time with HIV-seropositive patients without tuberculosis participating in a study of the natural history of HIV infection. Patients received follow-up observation prospectively until May 23, 1995 to determine survival rates and development of AIDS-defining opportunistic infections (OIs).


RESULTS
70 patients had tuberculosis; 120 did not. Mean CD4+ percentages were 12.4% and 12.5%, respectively. At study entry, 27% of those with tuberculosis had prior AIDS-defining OIs other than tuberculosis, compared with 10% of those without tuberculosis (p = .004). In multivariate survival analysis, controlling for CD4+ level, tuberculosis was not an independent predictor of increased other causes of AIDS-related mortality. However, in a logistic regression model, independent predictors of subsequent OIs included tuberculosis (hazard ratio, 4.1; 95% confidence intervals [CI], 1.9, 8.7), CD4+ count <100/mm3 (hazard ratio, 2.4; 95% CI, 1.1, 5.0) and prior OIs (hazard ration, 3.3; 95% CI, 1.3, 8.3).


CONCLUSIONS
Tuberculosis was not an independent predictor of increased non-tuberculosis-related mortality in HIV-seropositive patients but was associated with increased risk of development of OIs.
Munsiff
S S
SS
Department of Medicine, Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, New York, USA. muns301w@cdc.gov
Alpert
P L
PL
Gourevitch
M N
MN
Chang
C J
CJ
Klein
R S
RS
D017088:AIDS-Related Opportunistic Infections / Q000401:mortality / Q000503:physiopathology*; D018791:CD4 Lymphocyte Count; D016001:Confidence Intervals; D018450:Disease Progression; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000401:mortality / Q000503:physiopathology*; D006801:Humans; D008297:Male; D009519:New York City; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012044:Regression Analysis; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors; D014376:Tuberculosis / Q000150:complications / Q000401:mortality / Q000503:physiopathology*