title: Impact of HIV on mortality among patients treated for tuberculosis in Lima, Peru: a prospective cohort study.
abstract: BACKGROUND
  Human immunodeficiency virus (HIV)-associated tuberculosis deaths have decreased worldwide over the past decade. We sought to evaluate the effect of HIV status on tuberculosis mortality among patients undergoing treatment for tuberculosis in Lima, Peru, a low HIV prevalence setting.
  
  
  METHODS
  We conducted a prospective cohort study of patients treated for tuberculosis between 2005 and 2008 in two adjacent health regions in Lima, Peru (Lima Ciudad and Lima Este). We constructed a multivariate Cox proportional hazards model to evaluate the effect of HIV status on mortality during tuberculosis treatment.
  
  
  RESULTS
  Of 1701 participants treated for tuberculosis, 136 (8.0%) died during tuberculosis treatment. HIV-positive patients constituted 11.0% of the cohort and contributed to 34.6% of all deaths. HIV-positive patients were significantly more likely to die (25.1 vs. 5.9%, P < 0.001) and less likely to be cured (28.3 vs. 39.4%, P = 0.003). On multivariate analysis, positive HIV status (hazard ratio [HR] = 6.06; 95% confidence interval [CI], 3.96-9.27), unemployment (HR = 2.24; 95% CI, 1.55-3.25), and sputum acid-fast bacilli smear positivity (HR = 1.91; 95% CI, 1.10-3.31) were significantly associated with a higher hazard of death.
  
  
  CONCLUSIONS
  We demonstrate that positive HIV status was a strong predictor of mortality among patients treated for tuberculosis in the early years after Peru started providing free antiretroviral therapy. As HIV diagnosis and antiretroviral therapy provision are more widely implemented for tuberculosis patients in Peru, future operational research should document the changing profile of HIV-associated tuberculosis mortality.
authors.affiliation: Division of Infectious Diseases, Brigham and Women's Hospital, Boston, MA, USA. gvelasquez@bwh.harvard.edu.|Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA. gvelasquez@bwh.harvard.edu.|Department of Medicine, Harvard Medical School, Boston, MA, USA. gvelasquez@bwh.harvard.edu.
authors.forename: Gustavo E
authors.initials: GE
authors.lastname: Velásquez
authors.affiliation: Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, Atlanta, GA, USA. gzc2@cdc.gov.
authors.forename: J Peter
authors.initials: JP
authors.lastname: Cegielski
authors.affiliation: Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA. megan_murray@hms.harvard.edu.|Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA. megan_murray@hms.harvard.edu.|Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA. megan_murray@hms.harvard.edu.
authors.forename: Megan B
authors.initials: MB
authors.lastname: Murray
authors.affiliation: Oficina General de Investigación y Transferencia Tecnológica, Instituto Nacional de Salud, Lima, Perú. myaguim2002@yahoo.com.|Departamento Académico de Medicina Preventiva y Salud Pública, Universidad Nacional Mayor de San Marcos, Lima, Perú. myaguim2002@yahoo.com.
authors.forename: Martin J A
authors.initials: MJ
authors.lastname: Yagui
authors.affiliation: Laboratorio Nacional de Referencia de Micobacterias, Instituto Nacional de Salud, Lima, Perú. luisasencioss@yahoo.es.
authors.forename: Luis L
authors.initials: LL
authors.lastname: Asencios
authors.affiliation: Health, Nutrition and Population, The World Bank Group, Washington DC, USA. jbayonagarcia@worldbank.org.
authors.forename: Jaime N
authors.initials: JN
authors.lastname: Bayona
authors.affiliation: Estrategia Sanitaria Nacional de Prevención y Control de la Tuberculosis, Ministerio de Salud del Perú, Lima, Perú. bonasal@gmail.com.
authors.forename: César A
authors.initials: CA
authors.lastname: Bonilla
authors.affiliation: Estrategia Sanitaria Nacional de Prevención y Control de la Tuberculosis, Ministerio de Salud del Perú, Lima, Perú. rigeljave2008@yahoo.es.
authors.forename: Hector O
authors.initials: HO
authors.lastname: Jave
authors.affiliation: Dirección de Salud V Lima Ciudad, Programa de Control de Tuberculosis, Lima, Perú. gyclab5@yahoo.es.
authors.forename: Gloria
authors.initials: G
authors.lastname: Yale
authors.affiliation: Dirección de Salud IV Lima Este, Programa de Control de Tuberculosis, Lima, Perú. zoila118@hotmail.com.
authors.forename: Carmen Z
authors.initials: CZ
authors.lastname: Suárez
authors.affiliation: Servicio de Enfermedades Infecciosas y Tropicales, Hospital Nacional Hipólito Unanue, Lima, Perú. edsanch@gmail.com.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Sanchez
authors.affiliation: Servicio de Neumología, Instituto Nacional Cardiovascular "Carlos Alberto Peschiera Carrillo", Lima, Perú. christeorc@yahoo.com.
authors.forename: Christian
authors.initials: C
authors.lastname: Rojas
authors.affiliation: Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA. satwood@partners.org.
authors.forename: Sidney S
authors.initials: SS
authors.lastname: Atwood
authors.affiliation: Partners In Health / Socios En Salud, Lima, Perú. ccontreras_ses@pih.org.
authors.forename: Carmen C
authors.initials: CC
authors.lastname: Contreras
authors.affiliation: Partners In Health / Socios En Salud, Lima, Perú. jsantacruz_ses@pih.org.
authors.forename: Janeth
authors.initials: J
authors.lastname: Santa Cruz
authors.affiliation: Division of Infectious Diseases, Brigham and Women's Hospital, Boston, MA, USA. sshin@partners.org.|Department of Medicine, Harvard Medical School, Boston, MA, USA. sshin@partners.org.|Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA. sshin@partners.org.|Partners In Health / Socios En Salud, Lima, Perú. sshin@partners.org.
authors.forename: Sonya S
authors.initials: SS
authors.lastname: Shin
mesh_terms: D000328:Adult; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010568:Peru / Q000453:epidemiology; D015995:Prevalence; D016016:Proportional Hazards Models; D011446:Prospective Studies; D014376:Tuberculosis / Q000453:epidemiology / Q000209:etiology / Q000401:mortality*; D055815:Young Adult
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