Survival of a large cohort of HIV-infected tuberculosis patients in the era of highly active antiretroviral treatment.

OBJECTIVES

To determine the survival rate, predictive factors and causes of death in a cohort of human immunodeficiency virus (HIV) infected tuberculosis (TB) patients in the era of highly active antiretroviral treatment (HAART).

DESIGN

This retrospective cohort study included all HIV-infected TB patients reported in Barcelona between 1996 and 2006. A survival analysis was conducted based on the Kaplan-Meier estimator and Cox proportional hazards; hazard ratios (HRs) and their 95% confidence intervals (CIs) were calculated. Causes of death were classified using the International Classification of Diseases (ICD) 9 and ICD-10, and defined as acquired immune-deficiency syndrome (AIDS) related, non-AIDS-related or unknown.

RESULTS

Of the 792 patients included, 341 (43.1%) died. Survival at 10 years was 47.4% (95%CI 45.2-49.6). Poorer survival was observed in patients aged >30 years (HR 1.6, 95%CI 1.1-2.1), inner-city residents (HR 1.3, 95%CI 1.1-1.7), injecting drug users (HR 1.4, 95%CI 1.1-1.8), those with a non-cavitary radiological pattern (HR 1.5, 95%CI 1.0-2.2), those with <200 CD4/microl (HR 1.8, 95%CI 1.2-2.7) and those diagnosed with AIDS prior to their TB episode (HR 1.85, 95%CI 1.4-2.2). No differences were found for TB treatment (6 vs. 9 months) or for anti-tuberculosis drug resistance; 64.8% of the deaths were non-AIDS-related.

CONCLUSIONS

Poor survival was observed despite the availability of HAART, and non-AIDS-related mortality was high. Earlier HAART could help address AIDS and non-AIDS-related mortality.