title: Incidence of tuberculosis and survival after its diagnosis in patients infected with HIV-1 and HIV-2.
abstract: BACKGROUND
  In sub-Saharan Africa, tuberculosis (TB) is the most frequently diagnosed opportunistic infection and cause of death among HIV-infected patients. HIV-2 has been associated with less immune suppression, slower disease progression and longer survival.
  
  
  OBJECTIVE
  To examine whether the incidence of TB and survival after TB are associated with CD4 cell count rather than HIV type.
  
  
  METHODS
  Clinical and immunological data were retrospectively evaluated among an open clinic-based cohort of HIV-1- and HIV-2-infected patients to determine incidence of TB (first diagnosis > 28 days after HIV diagnosis) and subsequent mortality. Patients were grouped by CD4 cell count into those with < 200, 200-500 and > 500 x 10 cells/l.
  
  
  RESULTS
  Incident TB was diagnosed among 159 of 2012 patients, with 4973 person-years of observation time. In 105/159 (66.0%), the diagnosis was confirmed by direct microscopy or culture. Incidence of TB was highest in the group with < 200 x 10 cells/l (9.1/100 and 8.8/100 person-years in HIV-1 and HIV-2, respectively). Adjusted for CD4 cell count, there was no significant difference in incidence or mortality following TB between HIV-1- and HIV-2-infected patients. Mortality rate was higher in those with incident TB and HIV infection, most markedly in the group with the highest CD4 cell count (hazard ratio, 10.0; 95% confidence interval, 5.1-19.7).
  
  
  CONCLUSIONS
  Adjusted for CD4 cell count, incidence of TB was similar among HIV-1- and HIV-2-infected patients. Mortality rates after TB diagnosis were similar in both groups and high compared with those without TB.
authors.affiliation: London School of Hygiene and Tropical Medicine, London, UK. mvdsande@mrc.gm
authors.forename: Marianne A B
authors.initials: MA
authors.lastname: van der Sande
authors.forename: Maarten F
authors.initials: MF
authors.lastname: Schim van der Loeff
authors.forename: Rachel C
authors.initials: RC
authors.lastname: Bennett
authors.forename: Mary
authors.initials: M
authors.lastname: Dowling
authors.forename: Akum A
authors.initials: AA
authors.lastname: Aveika
authors.forename: Toyin O
authors.initials: TO
authors.lastname: Togun
authors.forename: Saihou
authors.initials: S
authors.lastname: Sabally
authors.forename: David
authors.initials: D
authors.lastname: Jeffries
authors.forename: Richard A
authors.initials: RA
authors.lastname: Adegbola
authors.forename: Ramu
authors.initials: R
authors.lastname: Sarge-Njie
authors.forename: Assan
authors.initials: A
authors.lastname: Jaye
authors.forename: Tumani
authors.initials: T
authors.lastname: Corrah
authors.forename: Samuel
authors.initials: S
authors.lastname: McConkey
authors.forename: Hilton C
authors.initials: HC
authors.lastname: Whittle
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000150:complications / Q000401:mortality*; D000328:Adult; D017954:Africa South of the Sahara / Q000453:epidemiology; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D005260:Female; D015497:HIV-1; D015498:HIV-2; D006801:Humans; D015994:Incidence; D008297:Male; D011446:Prospective Studies; D012189:Retrospective Studies; D016019:Survival Analysis; D014376:Tuberculosis / Q000150:complications / Q000401:mortality*