Municipal Heath Secretariat, Rio de Janeiro, RJ, Brazil.
Municipal Heath Secretariat, Rio de Janeiro, RJ, Brazil; Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil.
Braz J Infect Dis. 2014 Sep-Oct;18(5):491-5. doi: 10.1016/j.bjid.2014.02.004. Epub 2014 Apr 27.
The timing of highly active antiretroviral therapy (HAART) after a tuberculosis diagnosis in HIV-infected patients can affect clinical outcomes and survival. We compared survival after tuberculosis diagnosis in HIV-infected adults who initiated HAART and tuberculosis therapy simultaneously to those who delayed the start of HAART for at least two months.
The THRio cohort includes 17,983 patients receiving HIV care in 29 public clinics in Rio de Janeiro, Brazil. HAART-naïve patients at the time of a new TB diagnosis between September 2003 and June 2008 were included. Survival was measured in days from diagnosis of TB. We compared survival among patients who initiated HAART within 60 days of TB treatment (simultaneous - ST) to those who started HAART >60 days of TB treatment or never started (deferred - DT). Kaplan-Meier plots and Cox proportional hazards regression analyses were conducted.
Of 947 patients diagnosed with TB, 572 (60%) were HAART naïve at the time of TB diagnosis; 135 were excluded because of missing CD4 count results. Among the remaining 437 TB patients, 56 (13%) died during follow-up: 25 (10%) among ST patients and 31 (16%) in DT group (p=0.08). ST patients had lower median CD4 counts at TB diagnosis than DT patients (106 vs. 278, p<0.001). Cox proportional hazards utilizing propensity score analysis showed that DT patients were more likely to die (adjusted HR=1.89; 95% CI: 1.05-3.40; p=0.03).
HAART administered simultaneously with TB therapy was associated with improved survival after TB diagnosis. HAART should be given to patients with HIV-related TB as soon as clinically feasible.
在感染 HIV 的患者中，诊断出结核病后开始高效抗逆转录病毒治疗（HAART）的时机可能会影响临床结局和生存。我们比较了同时开始 HAART 和结核病治疗与至少延迟 2 个月开始 HAART 的 HIV 感染者结核病诊断后的生存情况。
THRio 队列包括在巴西里约热内卢 29 个公共诊所接受 HIV 护理的 17983 名患者。纳入 2003 年 9 月至 2008 年 6 月期间新诊断为结核病且未接受过 HAART 的患者。生存时间以从诊断结核病之日起的天数计算。我们比较了在结核病治疗后 60 天内开始 HAART 的患者（同时开始治疗-ST）与那些在结核病治疗后 60 天以上或从未开始 HAART 的患者（延迟开始治疗-DT）的生存情况。绘制 Kaplan-Meier 图和 Cox 比例风险回归分析。
在 947 例诊断为结核病的患者中，572 例（60%）在诊断结核病时为 HAART 初治患者；由于 CD4 计数结果缺失，135 例被排除在外。在剩余的 437 例结核病患者中，有 56 例（13%）在随访期间死亡：ST 组 25 例（10%），DT 组 31 例（16%）（p=0.08）。ST 患者结核病诊断时的中位 CD4 计数低于 DT 患者（106 对 278，p<0.001）。利用倾向评分分析的 Cox 比例风险显示，DT 患者死亡的可能性更高（调整后的 HR=1.89；95%CI：1.05-3.40；p=0.03）。
结核病治疗同时开始 HAART 与结核病诊断后生存改善相关。应尽快为 HIV 相关结核病患者提供 HAART。
