Article
Influence of HIV Infection on Mortality in a Cohort of Patients Treated for Tuberculosis in the Context of Wide Access to HAART, in Rio de Janeiro, Brazil
Registro en:
SCHMALTZ, Carolina Arana Stanis et al. Influence of HIV Infection on Mortality in a Cohort of Patients Treated for Tuberculosis in the Context of Wide Access to HAART, in Rio de Janeiro, Brazil. Journal of Acquired Immune Deficiency Syndromes, v. 52, n. 5, p. 623–628, Dec. 2009.
1525-4135
10.1097/QAI.0b013e3181b31e56
1944-7884
Autor
Schmaltz, Carolina Arana Stanis
Sant`Anna, Flávia Marinho
Neves, Simone Carvalho
Velasque, Luciane de Souza
Lourenço, Maria Cristina
Morgado, Mariza Gonçalves
Rolla, Valéria Cavalcanti
Lopes, Guilherme Santoro
Resumen
Objective: To analyze the influence of HIV serostatus on mortality related to tuberculosis (TB) in the context of wide access to highly active antiretroviral therapy (HAART) in a middle-income country. Methods: Prospective cohort study including patients who started antituberculous therapy between April 2000 and July 2005 at a referral center in Rio de Janeiro, Brazil. Results: Two hundred seven patients were enrolled, 106 were seropositive for HIV. There were 21 TB-related deaths in HIVpositive subjects (24.7 deaths per 100 patient-years) and 2 (2.5 deaths per 100 patient-years) among HIV-negative patients (rate ratio = 9.76, P , 0.001). Among HIV-infected subjects, TB-related mortality tended to be lower in patients treated with HAART [hazard ratio (HR) = 0.58, P = 0.06]. However, mortality among patients treated with HAARTwas still significantly increased as compared with HIVnegative patients (HR = 6.6, P = 0.014). In a Cox regression model
adjusted for disseminated TB (P = 0.04), and treatment with antituberculous regimens not containing rifampicin (P = 0.11), mortality was significantly higher among seropositive patients not on HAART compared with HIV-negative subjects (HR = 6.30, P = 0.024). Among subjects treated with HAART, there was a nonsignificant increase in mortality (rate ratio = 3.48, P = 0.14). Conclusions: HIV infection still has a substantial impact on
TB-related mortality in the context of wide access to HAART in a middle-income country. 2030-01-01