Outcome of HIV-Associated Tuberculosis in the Era of Highly Active Antiretroviral Therapy

• Published in: The Journal of infectious diseases Vol. 190; no. 9; pp. 1670 - 1676
• Main Authors: Dheda, Keertan, Lampe, Fiona C., Johnson, Margaret A., Lipman, Marc C.
• Format: Journal Article
• Language: English
• Published: Chicago, IL The University of Chicago Press 01.11.2004; University of Chicago Press; Oxford University Press
• Subjects: Adult; AIDS; AIDS-Related Opportunistic Infections - drug therapy; Antiretroviral Therapy, Highly Active; Antiretrovirals; Antitubercular Agents - adverse effects; Antitubercular Agents - therapeutic use; Bacterial diseases; Biological and medical sciences; CD4 Lymphocyte Count; Diseases; Female; Fundamental and applied biological sciences. Psychology; Health outcomes; Hematocrit; Highly active antiretroviral therapy; HIV; HIV Infections - complications; HIV Infections - drug therapy; HIV Infections - mortality; HIV/AIDS; Human bacterial diseases; Human immunodeficiency virus; Humans; Infections; Infectious diseases; London; Male; Medical sciences; Microbiology; Middle Aged; Miscellaneous; Mycobacterium tuberculosis; Risk Assessment; Treatment Outcome; Tuberculosis; Tuberculosis - complications; Tuberculosis - drug therapy; Tuberculosis - microbiology; Tuberculosis - mortality; Tuberculosis and atypical mycobacterial infections; Virology; London; Virus; Infection; Prognosis; Tuberculosis; Microbiology; Bacteriosis; Retroviridae; Antiviral; Mycobacterial infection; Human immunodeficiency virus; Lentivirus
• ISSN: 0022-1899; 1537-6613
• DOI: 10.1086/424676

Background. The benefit of highly active antiretroviral therapy (HAART) in the treatment of patients coinfected with tuberculosis (TB) and human immunodeficiency virus (HIV) is unclear because of concerns about treatmentrelated complications. Methods. We compared outcomes in patients starting TB treatment during the pre-HAART era (before 1996; n = 36) with those in patients starting treatment during the HAART era (during or after 1996; n = 60). Results. During a median of 3.6 years of follow-up, 49 patients died or had an AIDS event. Compared with patients in the pre-HAART group, those in the HAART group had a lower risk of death (cumulative at 4 years, 43% vs. 22%; P = .012) and of death or having an AIDS event (69% vs. 43%; P = .023). Event risk within the first 2 months of TB treatment was exceptionally high in patients with CD4+ cell counts <100 cells/mm3 and declined thereafter. HAART use during follow-up was associated with a marked reduction in event risk (adjusted hazard ratio, 0.38 [95% confidence interval, 0.16–0.91]). Conclusions. HAART substantially reduces new AIDS events and death in coinfected patients. Those with a CD4+ cell count <100 cells/mm3 have a high event risk during the intensive phase of anti-TB treatment. These data should be taken into account when deciding to delay HAART in coinfected patients with CD4+ cell counts <100 cells/mm3.