title: 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.
abstract: 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.
authors.affiliation: 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
authors.forename: Carolina Arana Stanis
authors.initials: CA
authors.lastname: Schmaltz
authors.forename: Flávia Marinho
authors.initials: FM
authors.lastname: Sant'Anna
authors.forename: Simone Carvalho
authors.initials: SC
authors.lastname: Neves
authors.forename: Luciane de Souza
authors.initials: Lde S
authors.lastname: Velasque
authors.forename: Maria Cristina
authors.initials: MC
authors.lastname: Lourenço
authors.forename: Mariza Gonçalves
authors.initials: MG
authors.lastname: Morgado
authors.forename: Valéria Cavalcanti
authors.initials: VC
authors.lastname: Rolla
authors.forename: Guilherme Santoro
authors.initials: GS
authors.lastname: Lopes
mesh_terms: 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*
chemical_list: D044966:Anti-Retroviral Agents; D000995:Antitubercular Agents