title: Effect of tuberculosis on the survival of women infected with human immunodeficiency virus.
abstract: Evidence regarding the effect of tuberculosis (TB) disease on progression of human immunodeficiency virus (HIV) disease is inconclusive. The authors estimated the effect of time-varying incident TB on time to acquired immunodeficiency syndrome (AIDS)-related mortality using a joint marginal structural Cox model. Between 1995 and 2002, 1,412 HIV type 1 (HIV-1)-infected women enrolled in the Women's Interagency HIV Study were followed for a median of 6 years. Twenty-nine women incurred incident TB, and 222 died of AIDS-related causes. Accounting for age, CD4 cell count, HIV-1 RNA level, serum albumin level, and non-TB AIDS at study entry, as well as for time-varying CD4 cell count, CD4 cell count nadir, HIV-1 RNA level, peak HIV-1 RNA level, serum albumin level, HIV-related symptoms, non-TB AIDS, anti-Pneumocystis jiroveci prophylaxis, antiretroviral therapy, and household income, the hazard ratio for AIDS-related death comparing time after incident TB with time before incident TB was 4.0 (95% confidence interval (CI): 1.2, 14). The effect of incident TB on mortality was similar among highly active antiretroviral therapy (HAART)-exposed women (hazard ratio = 4.3, 95% CI: 0.9, 22) and non-HAART-exposed women (hazard ratio = 3.9, 95% CI: 0.9, 17; interaction p = 0.91). Although results were imprecise because few women incurred TB, irrespective of HAART exposure, incident TB increases the hazard of AIDS-related death among HIV-infected women.
authors.affiliation: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. hlgatell@jhsph.edu
authors.forename: H
authors.initials: H
authors.lastname: López-Gatell
authors.forename: S R
authors.initials: SR
authors.lastname: Cole
authors.forename: N A
authors.initials: NA
authors.lastname: Hessol
authors.forename: A L
authors.initials: AL
authors.lastname: French
authors.forename: R M
authors.initials: RM
authors.lastname: Greenblatt
authors.forename: S
authors.initials: S
authors.lastname: Landesman
authors.forename: S
authors.initials: S
authors.lastname: Preston-Martin
authors.forename: K
authors.initials: K
authors.lastname: Anastos
mesh_terms: D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy / Q000401:mortality*; D015497:HIV-1; D006801:Humans; D011446:Prospective Studies; D014376:Tuberculosis / Q000150:complications / Q000401:mortality*; D014481:United States / Q000453:epidemiology