title: Outcomes among HIV-1 infected individuals first starting antiretroviral therapy with concurrent active TB or other AIDS-defining disease.
abstract: BACKGROUND
  Tuberculosis (TB) is common among HIV-infected individuals in many resource-limited countries and has been associated with poor survival. We evaluated morbidity and mortality among individuals first starting antiretroviral therapy (ART) with concurrent active TB or other AIDS-defining disease using data from the "Prospective Evaluation of Antiretrovirals in Resource-Limited Settings" (PEARLS) study.
  
  
  METHODS
  PARTICIPANTS WERE CATEGORIZED RETROSPECTIVELY INTO THREE GROUPS ACCORDING TO PRESENCE OF ACTIVE CONFIRMED OR PRESUMPTIVE DISEASE AT ART INITIATION: those with pulmonary and/or extrapulmonary TB ("TB" group), those with other non-TB AIDS-defining disease ("other disease"), or those without concurrent TB or other AIDS-defining disease ("no disease"). Primary outcome was time to the first of virologic failure, HIV disease progression or death. Since the groups differed in characteristics, proportional hazard models were used to compare the hazard of the primary outcome among study groups, adjusting for age, sex, country, screening CD4 count, baseline viral load and ART regimen.
  
  
  RESULTS
  31 of 102 participants (30%) in the "TB" group, 11 of 56 (20%) in the "other disease" group, and 287 of 1413 (20%) in the "no disease" group experienced a primary outcome event (p = 0.042). This difference reflected higher mortality in the TB group: 15 (15%), 0 (0%) and 41 (3%) participants died, respectively (p<0.001). The adjusted hazard ratio comparing the "TB" and "no disease" groups was 1.39 (95% confidence interval: 0.93-2.10; p = 0.11) for the primary outcome and 3.41 (1.72-6.75; p<0.001) for death.
  
  
  CONCLUSIONS
  Active TB at ART initiation was associated with increased risk of mortality in HIV-1 infected patients.
authors.affiliation: Departamento de Ciências Biológicas, Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil.
authors.forename: André R S
authors.initials: AR
authors.lastname: Périssé
authors.affiliation: Center for Biostatistics in AIDS Research, Harvard School of Public Health, Boston, Massachusetts, United States of America.
authors.forename: Laura
authors.initials: L
authors.lastname: Smeaton
authors.affiliation: Center for Biostatistics in AIDS Research, Harvard School of Public Health, Boston, Massachusetts, United States of America.
authors.forename: Yun
authors.initials: Y
authors.lastname: Chen
authors.affiliation: Asociacion Civil Impacta Salud y Educacion - Barranco, Lima, Peru.
authors.forename: Alberto
authors.initials: A
authors.lastname: La Rosa
authors.affiliation: Frontier Science and Technology Research Foundation, Amherst, New York, United States of America.
authors.forename: Ann
authors.initials: A
authors.lastname: Walawander
authors.affiliation: Frontier Science and Technology Research Foundation, Amherst, New York, United States of America.
authors.forename: Apsara
authors.initials: A
authors.lastname: Nair
authors.affiliation: Evandro Chagas Clinical Research Institute, Fiocruz, Rio de Janeiro, Brazil.
authors.forename: Beatriz
authors.initials: B
authors.lastname: Grinsztejn
authors.affiliation: Hospital Nossa Senhora da Conceição, Porto Alegre, Brazil.
authors.forename: Breno
authors.initials: B
authors.lastname: Santos
authors.affiliation: Kamuzu Central Hospital, Lilongwe, Malawi.
authors.forename: Cecilia
authors.initials: C
authors.lastname: Kanyama
authors.affiliation: University of Zimbabwe College of Health Sciences, Harare, Zimbabwe.
authors.forename: James
authors.initials: J
authors.lastname: Hakim
authors.affiliation: Mulinda Nyirenda, College of Medicine, University of Malawi, Blantyre, Malawi.
authors.forename: Mulinda
authors.initials: M
authors.lastname: Nyirenda
authors.affiliation: YRG Centre for AIDS Research and Education, Chennai, India.
authors.forename: Nagalingeswaran
authors.initials: N
authors.lastname: Kumarasamy
authors.affiliation: Nelson R. Mandela School of Medicine, Durban, South Africa.
authors.forename: Umesh G
authors.initials: UG
authors.lastname: Lalloo
authors.affiliation: Brown Medical School, Providence, Rhode Island, United States of America.
authors.forename: Timothy
authors.initials: T
authors.lastname: Flanigan
authors.affiliation: Division of Infectious Diseases, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, United States of America.
authors.forename: Thomas B
authors.initials: TB
authors.lastname: Campbell
authors.affiliation: Department of Biostatistics, Harvard School of Public Health, Boston, Massachusetts, United States of America.
authors.forename: Michael D
authors.initials: MD
authors.lastname: Hughes
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000401:mortality; D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D003906:Developing Countries; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy* / Q000401:mortality; D015497:HIV-1; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D014376:Tuberculosis / Q000150:complications* / Q000401:mortality; D014397:Tuberculosis, Pulmonary / Q000150:complications / Q000401:mortality; D019562:Viral Load