Antiretroviral therapy for HIV-infected tuberculosis patients saves lives but needs to be used more frequently in Thailand.
BACKGROUND
The impact of antiretroviral therapy (ART) on HIV-infected tuberculosis (TB) patients in public health programs in resource-limited settings is not well documented due to problems with statistical bias in observational studies.


METHODS
We measured the impact of ART on survival of HIV-infected TB patients in Thailand using a propensity score analysis that adjusted for factors associated with receiving ART.


RESULTS
Of 626 HIV-infected TB patients started on ART during TB treatment, 68 (11%) died compared with 295/643 (46%) of patients not prescribed ART (relative risk 0.24, 95% confidence interval: 0.19 to 0.30); in patients with very low CD4 (<10), 12/56 (21%) patients receiving ART died compared with 35/43 (81%) patients not receiving ART (relative risk 0.26, 95% confidence interval: 0.16 to 0.44). Patients treated in the private sector and in rural areas were less commonly prescribed ART. After controlling for propensity to receive ART, the hazard ratio for death among patients treated with ART was 0.17 (95% confidence interval: 0.12 to 0.24).


CONCLUSIONS
Patients who received ART had one sixth the risk of death of those not receiving ART. The survival benefit persisted even for those with a very low CD4 count. Expanding use of ART in HIV-infected TB patients will require increasing ART use in the private sector and rural areas.
Bamrasnaradura Institute, Nonthaburi, Thailand.
Natpatou
N
Sanguanwongse
Kevin P
KP
Cain
Patcharin
P
Suriya
Sriprapa
S
Nateniyom
Norio
N
Yamada
Wanpen
W
Wattanaamornkiat
Surin
S
Sumnapan
Wanchai
W
Sattayawuthipong
Samroui
S
Kaewsa-ard
Sakon
S
Ingkaseth
Jay K
JK
Varma
D000293:Adolescent; D000328:Adult; D000368:Aged; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D002648:Child; D002675:Child, Preschool; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy* / Q000276:immunology; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D013785:Thailand; D014376:Tuberculosis / Q000401:mortality*
D019380:Anti-HIV Agents