The prognosis of tuberculosis in adults infected with Human Immunodeficiency Virus (HIV-1)
Objectives: The primary objective of this study was to assess whether active tuberculosis (TB) accelerates the course of HIV-1 infection by measuring progression to AIDS and mortality in HIV-infected patients. Secondary objectives were to evaluate whether TB should be considered an AIDS-defining illness in an area with a high prevalence of TB, and to assess the risk factors for developing TB in HIV-1 infected patients. Setting: New Somerset and Groote Schuur Hospital adult HIV clinics, Department of Medicine, Faculty of Health Sciences, University of Cape Town. Design: Prospective patient cohort study with five years of follow-up. Sample: Adult HIV-infected patients presenting to the two HIV clinics between 1992 and 1996. Methods: The TB case definition was a positive culture or a compatible clinical picture combined with a positive smear or a histologic diagnosis. TB patients were treated with 6-month short course regimens. The Kaplan-Meier method was used to estimate the overall survival times of tuberculosis and non-tuberculosis patients. The generalized log rank test was used to compare the survival curves of these two groups. The Cox proportional hazards regression method was used to determine the risk of death associated with tuberculosis while adjusting for potential confounding variables (i.e. age, CD4+ count, history of an AIDS-defining illness, use of co-trimoxazole prophylaxis, and antiretroviral therapy, etc.). The Kaplan-Meier method was used to evaluate the prognosis of HIV-infected patients with TB vs the prognosis of HIV-infected with other HIV ( or AIDS, as defined by the WHO or the CDC staging systems) related diseases at baseline. The generalized log rank test was used to compare the survival curves of the TB group vs the other groups. Predictors of active TB in HIV-infected patients were assessed using univariate and multivariate logistic regression models.
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Department of Public Health and Family Medicine