Survival rate and risk factors of mortality among HIV/tuberculosis-coinfected patients with and without antiretroviral therapy.
BACKGROUND
The impact of antiretroviral therapy (ART) on survival among patients coinfected with HIV and tuberculosis (TB) has not been well established.


METHODS
A retrospective cohort study was conducted among HIV-infected patients with TB between January 2000 and December 2004. Patients were categorized into ART+ group (received ART) and ART- group (did not receive ART) and were followed until April 2005.


RESULTS
A total of 1003 patients were identified; 411 in ART+ group and 592 in ART- group. Median (interquartile range) CD4 count was 53 (20-129) cells/mm3. Survival rates at 1, 2, and 3 years after TB diagnosis were 96.1%, 94.0%, and 87.7% for ART+ group and 44.4%, 19.2%, and 9.3% for ART- group (log-rank test, P<0.001). Cox proportional hazard model showed that ART was associated with lower mortality rate; gastrointestinal TB and multidrug resistant TB were associated with higher mortality rate (P<0.05). Among patients in ART+ group, the patients who delayed ART>or=6 months after TB diagnosis had a higher mortality rate than those who initiated ART<6 months after TB diagnosis (P 0.018, hazard ratio=2.651, 95% confidence interval=1.152-6.102).


CONCLUSIONS
Antiretroviral therapy substantially reduces mortality rate among HIV/TB-coinfected patients. Initiation of ART within 6 months of TB diagnosis is associated with greater survival.
Manosuthi
Weerawat
W
Bamrasnaradura Infectious Diseases Institute, Ministry of Public Health, Nonthaburi and Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand. idweerawat@yahoo.com
Chottanapand
Suthat
S
Thongyen
Supeda
S
Chaovavanich
Achara
A
Sungkanuparph
Somnuek
S
D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy / Q000401:mortality*; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D013785:Thailand; D014376:Tuberculosis / Q000150:complications* / Q000401:mortality*; D014397:Tuberculosis, Pulmonary / Q000150:complications / Q000401:mortality
D019380:Anti-HIV Agents