HIV-specific health care utilization and mortality among tuberculosis/HIV coinfected persons.
Persons coinfected with tuberculosis (TB) and HIV are at high risk of death, in part due to suboptimal utilization of HIV-specific health care. We sought to better understand HIV-associated health care utilization and mortality in a retrospective cohort of TB/HIV coinfected cases reported in North Carolina 1993-2003. In this cohort, HIV was newly diagnosed during TB presentation for 34.2% of coinfected patients. Patients had advanced HIV (median CD4 104 cells/mm(3)) at TB diagnosis. Of 260 patients previously known to be HIV positive, 32.3% had seen a physician for HIV care in the previous 6 months and only 18.5% were taking antiretrovirals when TB was diagnosed; 34.8% of patients started antiretrovirals during TB treatment. Twenty-seven (5%) patients died prior to starting TB treatment; of those who survived, 13.6% (70/515) died prior to completing TB treatment, and 42.7% (220/515) died during a median 1408 days of follow-up. CD4 count (relative risk [RR] 0.53 per 100 cell increase, 95% confidence interval [CI] 0.34, 1.02) and highly active antiretroviral therapy (HAART) use during TB therapy (RR 0.37, 95% CI 0.13, 1.02) were independently associated with decreased mortality, while age greater than 45 (RR 2.18, 95% CI 1.11, 4.29) was independently associated with increased mortality during TB treatment. We conclude that TB/HIV coinfected patients had low utilization rates of HIV-specific care prior to TB diagnosis. Many did not receive potentially lifesaving HIV treatment while on TB therapy, and mortality was high as a result. Interventions to enhance utilization of HIV-related health care and integration of TB and HIV services should be studied to improve outcomes.
Gadkowski
L Beth
LB
Division of Infectious Diseases and International Health, Duke University Medical Center, Durham, NC 27710, USA.
Hamilton
Carol D
CD
Allen
Myra
M
Fortenberry
Ellen R
ER
Luffman
Julie
J
Zeringue
Elizabeth
E
Stout
Jason E
JE
D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000401:mortality / Q000628:therapy; D006296:Health Services / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009657:North Carolina / Q000453:epidemiology; D012189:Retrospective Studies; D015996:Survival Rate; D014397:Tuberculosis, Pulmonary / Q000150:complications* / Q000401:mortality / Q000628:therapy; D055815:Young Adult