title: Tuberculosis in a cohort of HIV-positive patients: epidemiology, clinical practice and treatment outcomes.
abstract: OBJECTIVE
  To describe tuberculosis (TB) incidence, risk factors, clinical presentation, disease management and outcomes in human immunodeficiency virus (HIV) infected patients from the CoRIS cohort, Spain, 2004-2010.
  
  
  METHODS
  Open multicentre cohort of antiretroviral treatment (ART) naïve patients at entry. Incidence and risk factors were evaluated using multivariate Poisson regression.
  
  
  RESULTS
  Among 6811 patients, 271 were eligible for the study and 198 for the estimation of the incidence rate; TB incidence ranged from 12.1 to 14.1/1000 person-years. TB was associated with low education level (rate ratio [RR] 2.65, 95%CI 1.73-4.07), being sub-Saharan African (RR 3.14, 95%CI 1.81-5.45), heterosexual (RR 2.01, 95%CI 1.22-3.29) or an injecting drug user (RR 2.11, 95%CI 1.20-3.69), not undergoing ART (RR 3.33, 95%CI 2.22-4.76), CD4 <200 cells/mm(3) (RR 5.20, 95%CI 3.25-8.33) and log-viral load of 4-5 (RR 5.44, 95%CI 3.28-9.02) or >5 (RR 13.10, 95%CI 8.27-20.76). Overall, 87% were new cases and 13% were previously treated cases; 175 (65%) were bacteriologically confirmed. Drug susceptibility testing was performed in 146 (83%) patients: resistance to first-line drugs was 11.1% in new and 36.4% in previously treated cases. Standard anti-tuberculosis treatment with four or three drugs was prescribed in respectively 55% and 36% of cases. Treatment default was 11%, and was higher among previously treated cases; 80% received ART during anti-tuberculosis treatment, 80% of new and 50% of previously treated cases were cured or completed treatment, and 18 (6.6%) died.
  
  
  CONCLUSIONS
  TB incidence in HIV-infected patients remains high. Interventions should include early HIV diagnosis and access to ART, enhanced bacteriological confirmation, wider use of four-drug regimens and reduction in treatment default.
authors.affiliation: Red de Investigación en Sida, Centro Nacional de Epidemiología, CIBER de Epidemiología y Salud Pública (CIBERESP), Spain.
authors.forename: S
authors.initials: S
authors.lastname: Monge
authors.affiliation: Aacute;rea de Vigilancia Epidemiológica del VIH/SIDA y Comportamientos de Riesgo, Plan Nacional sobre el SIDA, Ministerio de Sanidad, Servicios Sociales e Igualdad/Centro Nacional de Epidemiología, Instituto de Salud Carlos III and CIBERESP Madrid, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Diez
authors.affiliation: Hospital Universitario 12 de Octubre, Madrid, Spain.
authors.forename: F
authors.initials: F
authors.lastname: Pulido
authors.affiliation: Hospital Universitario de Donostia, San Sebastián, Spain.
authors.forename: J A
authors.initials: JA
authors.lastname: Iribarren
authors.affiliation: Hospital Universitari Son Espases, Palma de Mallorca, Spain.
authors.forename: A A
authors.initials: AA
authors.lastname: Campins
authors.affiliation: Hospital Universitario Miguel Servet, Zaragoza, Spain.
authors.forename: P
authors.initials: P
authors.lastname: Arazo
authors.affiliation: El Hospital Universitari i Politècnic La Fe, Valencia, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Montero
authors.affiliation: Hospital Clinic Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain.
authors.forename: J M
authors.initials: JM
authors.lastname: Miro
authors.affiliation: Hospital Universitario Ramón y Cajal, Madrid, Spain.
authors.forename: S
authors.initials: S
authors.lastname: Moreno
authors.affiliation: Red de Investigación en Sida, Centro Nacional de Epidemiología, CIBER de Epidemiología y Salud Pública (CIBERESP), Spain.
authors.forename: J
authors.initials: J
authors.lastname: Del Amo
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use; D000995:Antitubercular Agents / Q000627:therapeutic use; D016009:Chi-Square Distribution; D060085:Coinfection; D024901:Drug Resistance, Multiple, Bacterial; D004359:Drug Therapy, Combination; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D055985:Latent Tuberculosis / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology; D013997:Time Factors; D016896:Treatment Outcome; D014376:Tuberculosis / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D018088:Tuberculosis, Multidrug-Resistant / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology
chemical_list: D019380:Anti-HIV Agents; D000995:Antitubercular Agents