Whalen C, Horsburgh C R, Hom D, Lahart C, Simberkoff M, Ellner J
Department of Epidemiology and Biostatistics, University Hospitals of Cleveland, USA.
AIDS. 1997 Mar 15;11(4):455-60. doi: 10.1097/00002030-199704000-00008.
Infection with HIV adversely affects survival in patients with tuberculosis (TB), even when TB is effectively treated. The aim of this study was to identify the determinants of survival in HIV-associated TB.
Retrospective cohort study.
Four US academic medical centers.
An inception cohort of 112 HIV-infected patients (mean age 41 years, 96% men, 46% African American) with their first episode of culture-proven TB.
Observed survival from the date of diagnosis of TB to the date of death or censoring. Independent variables included demographics, HIV-related conditions, risk behavior for HIV, absolute CD4+ counts, and site of disease with Mycobacterium tuberculosis.
Of the 112 patients, 54 (48%) had pulmonary TB alone, 36 (32%) had both pulmonary and extra-pulmonary TB and 22 (20%) had extrapulmonary TB alone. Median CD4+ count was 95 x 10(6)/l (range, 2-767 x 10(6)/l). During follow-up, 45 patients (40%) died. Median survival was shortest in patients with both pulmonary and extrapulmonary disease (8.4 months), followed by extrapulmonary disease alone (15.6 months), then pulmonary disease (30.4 months; P < 0.001, log-rank test). Median survival was also reduced in patients with previous opportunistic infection and in those with CD4+ < 200 x 10(6)/l. In a proportional hazards regression analysis, which adjusted for CD4+ count, extrapulmonary disease and previous opportunistic infection were the only factors independently associated with shorter survival. Of the extrapulmonary sites of disease, TB meningitis was associated with the greatest risk of death.
The site of culture-proven TB at presentation and the history of previous opportunistic infection are important predictors of survival in HIV-infected patients with TB.
感染艾滋病毒会对结核病（TB）患者的生存产生不利影响，即便结核病得到有效治疗。本研究的目的是确定艾滋病毒相关结核病患者生存的决定因素。
回顾性队列研究。
美国四家学术医疗中心。
一个起始队列，包括112例首次经培养证实患有结核病的艾滋病毒感染患者（平均年龄41岁，96%为男性，46%为非裔美国人）。
从结核病诊断日期到死亡或失访日期的观察生存情况。自变量包括人口统计学特征、与艾滋病毒相关的疾病、艾滋病毒的风险行为、绝对CD4+细胞计数以及结核分枝杆菌疾病部位。
112例患者中，54例（48%）仅患有肺结核，36例（32%）同时患有肺结核和肺外结核，22例（20%）仅患有肺外结核。CD4+细胞计数中位数为95×10⁶/L（范围为2 - 767×10⁶/L）。随访期间，45例患者（40%）死亡。同时患有肺结核和肺外疾病的患者中位生存期最短（8.4个月），其次是仅患有肺外疾病的患者（15.6个月），然后是患有肺结核的患者（30.4个月；P < 0.001，对数秩检验）。既往有机会性感染的患者以及CD4+细胞计数<200×10⁶/L的患者中位生存期也缩短。在一项校正了CD4+细胞计数的比例风险回归分析中，肺外疾病和既往机会性感染是与生存期缩短独立相关的唯一因素。在肺外疾病部位中，结核性脑膜炎与死亡风险最高相关。
确诊时经培养证实的结核病部位以及既往机会性感染史是艾滋病毒感染的结核病患者生存的重要预测因素。
