Effect of pulmonary tuberculosis on mortality in patients receiving HAART.
OBJECTIVE
To estimate the effect of ongoing treatment for pulmonary tuberculosis (PTB) at time of initiation of HAART on subsequent risk of death.


METHODS
Evaluation of an open cohort of 7512 patients who initiated HAART between April 2004 and March 2007 in the Themba Lethu Clinic in Johannesburg, South Africa.


METHODS
Mortality hazard ratios were estimated using marginal structural Cox proportional hazards models to control for bias due to both confounding and loss to follow-up. Extensive sensitivity and secondary analyses were performed.


RESULTS
Although the crude hazard ratio for mortality in HAART-treated patients comparing those with and without treated PTB was 1.71 (95% confidence interval 1.31-2.23), the adjusted hazard ratio was 1.06 (95% confidence interval 0.75-1.49), indicating no difference in mortality risk. Similar effects were found when we considered different durations of time between initiation of PTB treatment and HAART, and sensitivity analysis confirmed main results. Secondary analysis suggested that individuals with PTB and other risk factors for death might be at particularly high risk of death during HAART treatment.


CONCLUSIONS
The increase in death that we observed among individuals with PTB at the time of HAART initiation appears not to be due to the to the presence of PTB, but instead to confounding factors such as low CD4 cell count, low BMI, and WHO stage IV disease. These results further demonstrate that initiation of HAART soon after initiation of PTB treatment is not likely to put patients at higher risk of death.
Westreich
Daniel
D
Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina 27599-7435, USA. djw@unc.edu
MacPhail
Patrick
P
Van Rie
Annelies
A
Malope-Kgokong
Babatyi
B
Ive
Prudence
P
Rubel
Dennis
D
Boulmé
Ronan
R
Eron
Joseph
J
Sanne
Ian
I
D017088:AIDS-Related Opportunistic Infections / Q000188:drug therapy / Q000276:immunology / Q000401:mortality*; D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D000995:Antitubercular Agents / Q000008:administration & dosage / Q000627:therapeutic use; D015992:Body Mass Index; D018791:CD4 Lymphocyte Count; D015986:Confounding Factors, Epidemiologic; D004334:Drug Administration Schedule; D004812:Epidemiologic Methods; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000276:immunology; D006801:Humans; D008297:Male; D011379:Prognosis; D013019:South Africa / Q000453:epidemiology; D014397:Tuberculosis, Pulmonary / Q000188:drug therapy / Q000276:immunology / Q000401:mortality*
D000995:Antitubercular Agents