Effect of simultaneous use of highly active antiretroviral therapy on survival of HIV patients with tuberculosis.
BACKGROUND
The optimal timing for initiation of highly active antiretroviral therapy (HAART) in patients with AIDS and tuberculosis (TB) is an unresolved question. To assess the effect of HAART on the survival of patients with TB, we designed this study.


METHODS
We selected all HIV patients included in the COMESEM cohort with TB diagnosis after 1996. Clinical and epidemiological data were registered. We compared patients who started HAART at the diagnosis of TB [simultaneous therapy (ST)] or not. Survival was assessed by Cox analysis.


RESULTS
Among the 6934 HIV patients included in the cohort, 1217 patients had TB, 322 of them (26.5%) after 1996. At the time of TB diagnosis, 45% of them started HAART (ST). There were no differences between groups regarding basal characteristics, except for a lower viral load in ST patients. ST therapy was associated with improved survival (hazard ratio 0.38; 95% confidence interval 0.20 to 0.72, P = 0.003). By univariate analysis, survival was also associated with no endovenous drug use and a later year of TB diagnosis. After adjusting for other prognostic variables, by Cox multivariate analysis, ST remained robustly associated with improved survival (hazard ratio 0.37; 95% confidence interval 0.17 to 0.66, P = 0.001).


CONCLUSIONS
Simultaneous HAART and TB treatment in HIV patients with TB is associated with improved survival.
Velasco
Maria
M
Infectious Diseases Section, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, Spain. mvelasco@fhalcorcon.es
Castilla
Virgilio
V
Sanz
José
J
Gaspar
Gabriel
G
Condes
Emilia
E
Barros
Carlos
C
Cervero
Miguel
M
Torres
Rafael
R
Guijarro
Carlos
C
D017088:AIDS-Related Opportunistic Infections / Q000188:drug therapy / Q000382:microbiology / Q000401:mortality*; D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D000995:Antitubercular Agents / Q000627:therapeutic use*; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy / Q000401:mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D016016:Proportional Hazards Models; D015996:Survival Rate; D016896:Treatment Outcome; D014397:Tuberculosis, Pulmonary / Q000150:complications / Q000188:drug therapy / Q000401:mortality*
D000995:Antitubercular Agents