title: Tuberculosis is associated with non-tuberculosis-related deaths among HIV/AIDS patients in Rio de Janeiro.
abstract: METHODS
  Human immunodeficiency virus (HIV) infected patients followed in a large cohort in Rio de Janeiro, Brazil.
  
  
  OBJECTIVE
  To evaluate the association of tuberculosis (TB) and other covariables with non-TB-related (NTR) causes of death (CODs).
  
  
  METHODS
  Patients aged >18 years were followed from 1997 to 2009, until death or 31 December 2009, whichever was earlier. CODs were ascertained using a standardised algorithm. TB diagnosis and prophylaxis followed Brazilian guidelines. Poisson models were used to calculate adjusted rate ratios (aRRs).
  
  
  RESULTS
  Of 2887 patients included in the study, 761 had TB (26.4%). NTR death rates were twice as high among patients with TB (4/100 vs. 2.09/100 patient-years). TB was associated with NTR deaths (aRR 1.4, 95%CI 1.05-1.86, P = 0.01). Highly active antiretroviral treatment (HAART) was protective against NTR (aRR 0.46, 95%CI 0.34-0.61, P < 0.001). Among patients who had never had active TB, prophylaxis was also protective against NTR (aRR 0.45, P = 0.04). The CD4 cell count increase was very modest for both TB and NTR CODs compared to those who did not die (0 vs. 249 cells, P < 0.001).
  
  
  CONCLUSIONS
  TB was significantly associated with increased NTR CODs, indicating rapid progression of disease and increased long-term risk of mortality, probably related to persistent immunodeficiency or incomplete immune recovery. Our results confirm the benefits of HAART and TB prophylaxis.
authors.affiliation: Programa de Computação Científica, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil.
authors.forename: A G
authors.initials: AG
authors.lastname: Pacheco
authors.affiliation: Instituto de Pesquisa Clínica Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil.
authors.forename: V G
authors.initials: VG
authors.lastname: Veloso
authors.affiliation: Instituto de Pesquisa Clínica Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil.
authors.forename: E P
authors.initials: EP
authors.lastname: Nunes
authors.affiliation: Instituto de Pesquisa Clínica Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil.
authors.forename: S
authors.initials: S
authors.lastname: Ribeiro
authors.affiliation: Instituto de Pesquisa Clínica Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil.
authors.forename: M R C
authors.initials: MR
authors.lastname: Guimarães
authors.affiliation: Instituto de Pesquisa Clínica Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil.
authors.forename: M C
authors.initials: MC
authors.lastname: Lourenço
authors.affiliation: Instituto de Doenças do Tórax, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil.
authors.forename: F C Q
authors.initials: FC
authors.lastname: Mello
authors.affiliation: Instituto de Pesquisa Clínica Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil.
authors.forename: B
authors.initials: B
authors.lastname: Grinsztejn
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active; D000995:Antitubercular Agents / Q000627:therapeutic use; D001938:Brazil / Q000453:epidemiology; D002423:Cause of Death; D016009:Chi-Square Distribution; D060085:Coinfection; D016208:Databases, Factual; D018450:Disease Progression; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000188:drug therapy / Q000276:immunology / Q000401:mortality*; D006801:Humans; D016867:Immunocompromised Host; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014376:Tuberculosis / Q000175:diagnosis / Q000276:immunology / Q000401:mortality* / Q000517:prevention & control; D014504:Urban Health
chemical_list: D019380:Anti-HIV Agents; D000995:Antitubercular Agents