title: Human Immunodeficiency Virus Infection-Associated Mortality during Pulmonary Tuberculosis Treatment in Six Provinces of China.
abstract: OBJECTIVE
  To investigate the risk factors attributable to tuberculosis-related deaths in areas with human immunodeficiency virus (HIV) infection epidemics.
  
  
  METHODS
  A prospective cohort study of newly registered patients in tuberculosis (TB) dispensaries in six representative Chinese provinces was conducted from September 1, 2009 to August 31, 2011. Risk factors for TB-associated death were identified through logistic regression analysis.
  
  
  RESULTS
  Of 19,103 newly registered pulmonary TB patients, 925 (4.8%) were found to be HIV-positive. Miliary TB and acid-fast bacillus smear-negative TB were more common among these patients. Out of a total of 322 (1.7%) deaths that occurred during TB treatment, 85 (26%) of the patients were co-infected with HIV. Multivariate analysis revealed that HIV infection was the strongest predictor of death [adjusted odds ratio (aOR) 7.86]. Other significant mortality risk factors included presentation with miliary TB (aOR 4.10; 95% confidence interval: 2.14-7.88), ⋝35 years of age (aOR 3.04), non-Han ethnicity (aOR 1.67), and farming as an occupation (aOR 1.59). For patients with TB/HIV co-infection, miliary TB was the strongest risk factor for death (aOR 5.48). A low CD4 count (⋜200 cells/µL) (aOR 3.27) at the time of TB treatment initiation and a lack of antiretroviral therapy (ART) administration (aOR 3.78) were also correlated with an increased risk of death.
  
  
  CONCLUSIONS
  Infection with HIV was independently associated with increased mortality during TB treatment. Offering HIV testing at the time of diagnosis with TB, early TB diagnosis among HIV/acquired immunodeficiency syndrome patients, and the timely provision of ART were identified as the key approaches that could reduce the number of HIV-associated TB deaths.
authors.affiliation: Center for Tuberculosis Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China.
authors.forename: Yu Ji
authors.initials: YJ
authors.lastname: Lai
authors.affiliation: Center for Tuberculosis Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China.
authors.forename: Er Yong
authors.initials: EY
authors.lastname: Liu
authors.affiliation: Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China.
authors.forename: Li Ming
authors.initials: LM
authors.lastname: Wang
authors.affiliation: Division of Infectious Diseases and International Medicine, University of South Florida, Morsani College of Medicine, Tampa, Florida 33610, United States of America.
authors.forename: Jamie P
authors.initials: JP
authors.lastname: Morano
authors.affiliation: Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China.
authors.forename: Ning
authors.initials: N
authors.lastname: Wang
authors.affiliation: Yale University School of Public Health, New Haven, Connecticut 06520, United States of America.
authors.forename: Kaveh
authors.initials: K
authors.lastname: Khoshnood
authors.affiliation: Center for Tuberculosis Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China.
authors.forename: Lin
authors.initials: L
authors.lastname: Zhou
authors.affiliation: Center for Tuberculosis Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China.
authors.forename: Shi Ming
authors.initials: SM
authors.lastname: Cheng
mesh_terms: D000328:Adult; D002681:China / Q000453:epidemiology; D015331:Cohort Studies; D060085:Coinfection / Q000401:mortality* / Q000628:therapy*; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000401:mortality*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D014397:Tuberculosis, Pulmonary / Q000150:complications* / Q000401:mortality / Q000628:therapy*
keywords: Acquired immunodeficiency syndrome; Human immunodeficiency virus; Mortality; Tuberculosis