Abstract
Antiretroviral therapy (ART) is lifesaving in patients with advanced HIV infection, but the magnitude of benefit in HIV-infected patients receiving tuberculosis (TB) treatment remains uncertain, and population-based data from developing countries are limited. We prospectively collected data about HIV-infected TB patients from February 2003 through January 2004 in Ubon-ratchathani, Thailand. During 12 months, HIV was diagnosed in 329 (14%) of 2,342 patients registered for TB treatment. Of patients with known outcomes, death during TB treatment occurred in 5 (7%) of 71 who received ART and 94 (43%) of 219 who did not. Using multivariate analysis, we found a large reduction in the odds of death for patients receiving ART before or during TB treatment (odds ratio, 0.2; 95% confidence interval, 0.1-0.5), adjusting for CD4 count, smear status, co-trimoxazole use, and treatment facility. ART is associated with a substantial reduction in deaths during TB treatment for HIV-infected TB patients in Thailand.
Highlights
Tuberculosis (TB) is one of the most common opportunistic infections and causes of death in HIV-infected persons [1]
Several studies have documented that Antitretroviral therapy (ART) reduces the likelihood of death during TB treatment of HIV-infected TB patients, but these studies relied on retrospective data collection, occurred outside
“Culture negative” includes only patients with a sputum culture negative for Mycobacterium tuberculosis (MTB). ‡Compared with culture positive. In this prospective, population-based study from a rural province in northeastern Thailand, we documented a high rate of death in HIV-infected TB patients and a substantial reduction in the risk for death during TB treatment for patients receiving ART
Summary
Tuberculosis (TB) is one of the most common opportunistic infections and causes of death in HIV-infected persons [1]. The proportion of HIV-infected TB patients who die during TB treatment is high: an estimated 6%–39% die during TB treatment in sub-Saharan Africa [2,3]. Almost 600,000 persons are currently HIV infected, and >90,000 TB cases are estimated to occur annually [2,9]. One fourth of persons in whom AIDS was diagnosed first have TB, and an estimated 12% of TB cases in Thailand are HIV associated, the proportion is as high as 40% in some provinces [10]. Several studies have documented that ART reduces the likelihood of death during TB treatment of HIV-infected TB patients, but these studies relied on retrospective data collection, occurred outside. We analyzed data from a prospective, population-based surveillance system to estimate the benefit of ART on reducing mortality during TB treatment in HIVinfected TB patients living in rural Thailand
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