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.