Influence of HIV infection on mortality in a cohort of patients treated for tuberculosis in the context of wide access to HAART, in Rio de Janeiro, Brazil.
OBJECTIVE
To analyze the influence of HIV serostatus on mortality related to tuberculosis (TB) in the context of wide access to highly active antiretroviral therapy (HAART) in a middle-income country.


METHODS
Prospective cohort study including patients who started antituberculous therapy between April 2000 and July 2005 at a referral center in Rio de Janeiro, Brazil.


RESULTS
Two hundred seven patients were enrolled, 106 were seropositive for HIV. There were 21 TB-related deaths in HIV-positive subjects (24.7 deaths per 100 patient-years) and 2 (2.5 deaths per 100 patient-years) among HIV-negative patients (rate ratio = 9.76, P < 0.001). Among HIV-infected subjects, TB-related mortality tended to be lower in patients treated with HAART [hazard ratio (HR) = 0.58, P = 0.06]. However, mortality among patients treated with HAART was still significantly increased as compared with HIV-negative patients (HR = 6.6, P = 0.014). In a Cox regression model adjusted for disseminated TB (P = 0.04), and treatment with antituberculous regimens not containing rifampicin (P = 0.11), mortality was significantly higher among seropositive patients not on HAART compared with HIV-negative subjects (HR = 6.30, P = 0.024). Among subjects treated with HAART, there was a nonsignificant increase in mortality (rate ratio = 3.48, P = 0.14).


CONCLUSIONS
HIV infection still has a substantial impact on TB-related mortality in the context of wide access to HAART in a middle-income country.
Schmaltz
Carolina Arana Stanis
CA
Clinical Research Laboratory on Mycobacteriosis of Instituto de Pesquisa Clínica Evandro Chagas-Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, Brazil. carolina.stanis@ipec.fiocruz.br
Sant'Anna
Flávia Marinho
FM
Neves
Simone Carvalho
SC
Velasque
Luciane de Souza
Lde S
Lourenço
Maria Cristina
MC
Morgado
Mariza Gonçalves
MG
Rolla
Valéria Cavalcanti
VC
Lopes
Guilherme Santoro
GS
D017088:AIDS-Related Opportunistic Infections / Q000188:drug therapy / Q000276:immunology / Q000401:mortality*; D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active; D000995:Antitubercular Agents / Q000627:therapeutic use; D001938:Brazil / Q000453:epidemiology; D005260:Female; D006679:HIV Seropositivity / Q000150:complications* / Q000188:drug therapy*; D015497:HIV-1; D006801:Humans; D008297:Male; D011446:Prospective Studies; D012307:Risk Factors; D014376:Tuberculosis / Q000188:drug therapy / Q000401:mortality*
D044966:Anti-Retroviral Agents; D000995:Antitubercular Agents