title: Antiretroviral therapy improves survival among TB-HIV co-infected patients who have CD4+ T-cell count above 350cells/mm3.
abstract: BACKGROUND
  Co-infection with Mycobacterium tuberculosis remains a leading cause of morbidity and mortality among HIV infected individuals especially in developing countries. Early initiation of cART in these patients when CD4+ T cell count is less than 200cells/mm3has reduced disease progression and mortality. However for patients with higher CD4+ T cell counts greater than 350cells/mm3evidence is conflicting. In this study we seek to evaluate the effectiveness of cART in reducing mortality among TB-HIV co-infected patients with CD4 + T cells above 350cells/mm3at the time of TB diagnosis.
  
  
  METHODS
  In a retrospective cohort study we analyzed 337 HIV-TB co-infected patients with CD4+ T cells above 350cells/mm3at baseline who were diagnosed between 2006 and 2012 in the southern province of Zambia. The primary outcome was all-cause mortality. We estimated the effect of cART by comparing survival according to cART and controlling for differential loss to follow-up.
  
  
  RESULTS
  Of the 257 patients on cART, 22 died (9 %) and 20 (8 %) were lost to follow-up; of 80 patients not on cART, 20 died (25 %) and 19 (24 %) were lost to follow-up. Patients treated with cART had better survival compared to those not treated (P < 0 · 0001, log-rank test). In a proportional hazard regression adjusting for Cotrimoxazole, the risk of death was reduced by 78 % with cART (95 % CI: 0 · 47, 0 · 91). In a propensity score analysis, the effect of cART was still beneficial.
  
  
  CONCLUSIONS
  In patients with HIV-associated TB and CD4+ T cells above 350cells/mm3, treatment with cART reduced mortality for up to 4 years as compared to no cART and was associated with better retention in care.
authors.affiliation: Ministry of Health, Southern Provincial Medical Office, Choma, Zambia. simon.mutembo@gmail.com.
authors.forename: Simon
authors.identifier: http://orcid.org/0000-0002-5389-5966
authors.initials: S
authors.lastname: Mutembo
authors.affiliation: Ministry of Health, Southern Provincial Medical Office, Choma, Zambia.
authors.forename: Jane N
authors.initials: JN
authors.lastname: Mutanga
authors.affiliation: Ministry of Health, Southern Provincial Medical Office, Choma, Zambia.
authors.forename: Kebby
authors.initials: K
authors.lastname: Musokotwane
authors.affiliation: Ministry of Health, Southern Provincial Medical Office, Choma, Zambia.
authors.forename: Lutangu
authors.initials: L
authors.lastname: Alisheke
authors.affiliation: Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Health Sciences Campus, 101 Buck Road, Athens, Georgia, 30602, USA.
authors.forename: Christopher C
authors.initials: CC
authors.lastname: Whalen
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000188:drug therapy / Q000382:microbiology / Q000401:mortality; D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D015496:CD4-Positive T-Lymphocytes; D015331:Cohort Studies; D018450:Disease Progression; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality*; D006801:Humans; D053208:Kaplan-Meier Estimate; D059012:Lost to Follow-Up; D008297:Male; D012189:Retrospective Studies; D014376:Tuberculosis / Q000188:drug therapy / Q000401:mortality* / Q000821:virology; D015024:Zambia
chemical_list: D019380:Anti-HIV Agents
keywords: Antiretroviral therapy; CD4+ T-cell count > 350cells/mm3; HIV; Survival; Tuberculosis