Having pulmonary tuberculosis raised the risk of all-cause mortality 37% in Ugandan adults starting ART in a prospectively studied cohort of 22,477 people.
Although it is well known that TB affects survival of people coinfected with HIV, the magnitude of that impact is not well understood. To address that question, researchers conducted this study of 22,477 adults who began ART between August 2000 and June 2009 in Uganda. They determined who had pulmonary TB when they began ART and figured how many people died during follow-up. The investigators used a method called propensity-score matching to account for variables that might affect death in people with or without TB.
Of the 22,477 cohort members, 7.5% had active pulmonary TB when they began ART. People with TB were more likely to be men, have an AIDS-defining illness, have World Health Organization (WHO) stage 3 or 4 disease, and have a lower pre-ART CD4 count (P < 0.001). During follow-up 10.47% of people with TB and 6.38% without TB died.
The crude estimate of death indicated that people with TB when they began ART had almost a 75% higher risk of death (hazard ratio [HR] 1.74, 95% confidence interval [CI] 1.49 to 2.04). Among 1686 propensity score-matched pairs with and without TB, the risk of all-cause mortality was 37% higher in the TB group (HR 1.37, 95% CI 1.08 to 1.75).
The authors believe this is the largest cohort of HIV-positive people taking ART in a single African country that has been evaluated for mortality in people coinfected with TB. They note that their findings are complementary to results of the recent SAPIT, CAMELIA, and STRIDE trials, which found that earlier ART in people being treated for TB improves survival.
The investigators conclude that their results “validate the WHO guidelines that urge a more aggressive approach to management of both TB and HIV.”
Source: Rong Chu, Edward J. Mills, Joseph Beyene, Eleanor Pullenayegum, Celestin Bakanda, Jean B. Nachega, P.J. Devereaux, Lehana Thabane. Impact of tuberculosis on mortality among HIV-infected patients receiving antiretroviral therapy in Uganda: a prospective cohort analysis. AIDS Research and Therapy. 2013; 10: 19.
Complete article provided by AIDS Research and Therapy, an open-access journal
Source: IAS