Chemoprophylaxis for tuberculosis and survival of HIV-infected patients in Brazil.
OBJECTIVE
To study the impact of chemoprophylaxis for tuberculosis on the survival of HIV-infected patients with a positive tuberculin skin test.


METHODS
Prospective observational cohort study.


METHODS
Outpatient clinic of a university hospital, in Rio de Janeiro, Brazil.


METHODS
Two-hundred and ninety-seven patients with a positive tuberculin skin test (reaction > or = 5mm) who were admitted to the cohort between January 1991 and December 1994. Follow-up ended on September 30, 1998.


METHODS
The use of chemoprophylaxis for tuberculosis.


METHODS
Death was the primary outcome variable. The occurrence of tuberculosis was studied as a secondary outcome. Cox regression models were used in these analyses.


RESULTS
The median follow-up time was 43.6 months. Chemoprophylaxis was used by 128 (43%) of the patients. The use of chemoprophylaxis was associated with a reduction in risk for tuberculosis (hazard ratio, 0.38; 95% confidence interval, 0.14-1.04; P = 0.05). In a regression model adjusted for baseline CD4 cell count, chemoprophylaxis was associated with longer survival (hazard ratio, 0.24; 95% confidence interval, 0.09-0.65; P = 0.002).


CONCLUSIONS
Anti-tuberculosis chemoprophylaxis was associated with a substantially prolonged survival among purified protein derivative-positive HIV-infected patients in Brazil. These data have important implications for the clinical care of patients with HIV infection in areas of the world with a high prevalence of Mycobacterium tuberculosis infection.
de Pinho
A M
AM
Infectious Diseases Service, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
Santoro-Lopes
G
G
Harrison
L H
LH
Schechter
M
M
D017088:AIDS-Related Opportunistic Infections / Q000401:mortality* / Q000517:prevention & control*; D000328:Adult; D000995:Antitubercular Agents / Q000627:therapeutic use*; D001938:Brazil / Q000453:epidemiology; D018890:Chemoprevention; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012044:Regression Analysis; D016019:Survival Analysis; D014374:Tuberculin Test; D014397:Tuberculosis, Pulmonary / Q000401:mortality* / Q000517:prevention & control*
D000995:Antitubercular Agents