title: Association between tuberculosis and HIV disease progression in a high tuberculosis prevalence area.
abstract: METHODS
  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.
  
  
  METHODS
  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/microliter and in those without AIDS at baseline.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Public Health and Medicine, University of Cape Town, Cape Town, South Africa.
authors.forename: M
authors.initials: M
authors.lastname: Badri
authors.forename: R
authors.initials: R
authors.lastname: Ehrlich
authors.forename: R
authors.initials: R
authors.lastname: Wood
authors.forename: T
authors.initials: T
authors.lastname: Pulerwitz
authors.forename: G
authors.initials: G
authors.lastname: Maartens
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000453:epidemiology* / Q000276:immunology; D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000150:complications* / Q000453:epidemiology / Q000276:immunology; D015497:HIV-1 / Q000502:physiology; D006801:Humans; D008297:Male; D015995:Prevalence; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018570:Risk Assessment; D013019:South Africa / Q000453:epidemiology; D013997:Time Factors; D014397:Tuberculosis, Pulmonary / Q000150:complications* / Q000453:epidemiology / Q000276:immunology; D014779:Virus Replication
chemical_list: D019380:Anti-HIV Agents