Changing clinical presentation and survival in HIV-associated tuberculosisafter highly active antiretroviral therapy

Citation
E. Girardi et al., Changing clinical presentation and survival in HIV-associated tuberculosisafter highly active antiretroviral therapy, J ACQ IMM D, 26(4), 2001, pp. 326-331
Citations number
35
Language
INGLESE
art.tipo
Article
Categorie Soggetti
Clinical Immunolgy & Infectious Disease",Immunology
Journal title
JOURNAL OF ACQUIRED IMMUNE DEFICIENCY SYNDROMES
ISSN journal
1525-4135 → ACNP
Volume
26
Issue
4
Year of publication
2001
Pages
326 - 331
Database
ISI
SICI code
1525-4135(20010401)26:4<326:CCPASI>2.0.ZU;2-S
Abstract
Objective: To assess changes in clinical presentation and outcome of HIV-as sociated tuberculosis (TB) before and after widespread implementation of hi ghly active antiretroviral therapy (HAART). Methods: We reviewed clinical charts of HIV-infected patients with culture confirmed pulmonary TB in two referral clinical centers in Rome, Italy. The 67 patients diagnosed in 1995 to 1996 were compared with 51 patients diagn osed in 1997 to 1998. To analyze factors associated with survival we used a Cox model including antiretroviral therapy as a time-dependent covariate. Results: Patients diagnosed in 1997 to 1998 were more likely to have TB as the first AIDS-defining illness (78% versus 58%, p < .05), to have HIV diag nosed <2 months before TB (33% vs. 7%, p < .005) and to have typical chest radiograph pattern (45% vs. 25%,p < .05), and had a higher CD4(+) count (me dian 105 vs. 43, p < .005). Survival at 1 year was 80% for patients diagnos ed in 1997 to 1998 vs. 65% for those diagnosed in 1995 to 1996 (p by log-ra nk = .02). After adjusting at multivariate analysis, time period of diagnos is was not confirmed as associated with survival (hazard ratio, 1.05; 95% c onfidence interval, 0.39-2.81). Age, CD4+ cell count < 25/mm(3), and AIDS-d efining illnesses before TB diagnosis were all associated with an higher ri sk of death, whereas a decreased risk of death was observed in patients sta rting a triple combination antiretroviral therapy after TB diagnosis (hazar d ratio, 0.14; 95% confidence interval, 0.03-0.57). Conclusions: Cases of HIV-associated TB occurring in patients with advanced immunosuppression and presenting with atypical radiologic appearance tend to be relatively less common in the HAART era. HAART is a major factor in p rolonging survival in these patients.