title: Impact of previous ART and of ART initiation on outcome of HIV-associated tuberculosis.
abstract: BACKGROUND
  Combination antiretroviral therapy (cART) has progressively decreased mortality of HIV-associated tuberculosis .To date, however, limited data on tuberculosis treatment outcomes among coinfected patients who are not ART-naive at the time of tuberculosis diagnosis are available.
  
  
  METHODS
  A multicenter, observational study enrolled 246 HIV-infected patients diagnosed with tuberculosis, in 96 Italian infectious diseases hospital units, who started tuberculosis treatment. A polytomous logistic regression model was used to identify baseline factors associated with the outcome. A Poisson regression model was used to explain the effect of ART during tuberculosis treatment on mortality, as a time-varying covariate, adjusting for baseline characteristics.
  
  
  RESULTS
  Outcomes of tuberculosis treatment were as follows: 130 (52.8%) were successfully treated, 36 (14.6%) patients died in a median time of 2 months (range: 0-16), and 80 (32.6%) had an unsuccessful outcome. Being foreign born or injecting drug users was associated with unsuccessful outcomes. In multivariable Poisson regression, cART during tuberculosis treatment decreased the risk of death, while this risk increased for those who were not ART-naive at tuberculosis diagnosis.
  
  
  CONCLUSIONS
  ART during tuberculosis treatment is associated with a substantial reduction of death rate among HIV-infected patients. However, patients who are not ART-naive when they develop tuberculosis remain at elevated risk of death.
authors.affiliation: Clinical Epidemiology Unit, Department of Epidemiology and Clinical Department, National Institute for Infectious Diseases L. Spallanzani, Via Portuense 292, 00149 Rome, Italy. enrico.girardi@inmi.it
authors.forename: Enrico
authors.initials: E
authors.lastname: Girardi
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Palmieri
authors.forename: Claudio
authors.initials: C
authors.lastname: Angeletti
authors.forename: Paola
authors.initials: P
authors.lastname: Vanacore
authors.forename: Alberto
authors.initials: A
authors.lastname: Matteelli
authors.forename: Andrea
authors.initials: A
authors.lastname: Gori
authors.forename: Sergio
authors.initials: S
authors.lastname: Carbonara
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Ippolito
mesh_terms: D000328:Adult; D000368:Aged; D019380:Anti-HIV Agents / Q000008:administration & dosage / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active / Q000401:mortality; D000995:Antitubercular Agents / Q000008:administration & dosage / Q000627:therapeutic use; D018791:CD4 Lymphocyte Count; D060085:Coinfection; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality / Q000821:virology; D015497:HIV-1 / Q000502:physiology*; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000187:drug effects / Q000502:physiology*; D012044:Regression Analysis; D015996:Survival Rate; D016896:Treatment Outcome; D014397:Tuberculosis, Pulmonary / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality / Q000821:virology; D019562:Viral Load / Q000187:drug effects
chemical_list: D019380:Anti-HIV Agents; D000995:Antitubercular Agents