 |
Mortality associated with tuberculosis in HIV positive and negative patients in the HAART era, in Rio de Janeiro, Brazil
Presented by Valéria Rolla, Brazil.
Schmaltz C.1, Marinho F.1, Souza S.1, Lourenço C.2, Morgado M.1, Rolla V.1, Lopes G.3
1IPEC/FIOCRUZ, Infectious Diseases, Rio de Janeiro, Brazil, 2IPEC/FIOCRUZ, Bacteriology Laboratory, Rio de Janeiro, Brazil, 3HUCFF/UFRJ, Infectious Diseases, Rio de Janeiro, Brazil
Objectives: To compare mortality associated with tuberculosis (TB) between HIV infected patients and HIV negative subjects who started anti-TB therapy and to analyze variables that influenced the risk of TB-associated death.
Methods: A prospective cohort study was conducted at the Tuberculosis Referral Center of Instituto de Pesquisa Evandro Chagas - Fiocruz, Rio de Janeiro, Brazil, from January 2000 to August 2006. Patients who had a positive culture for Mycobacterium tuberculosis and gave a written informed consent were included in the study. Tuberculosis and HAART were offered following the Brazilian National Recommendations.
Results: Two hundred and seven patients were enrolled, 106 HIV positive and 101 HIV negative patients. Disseminated TB (p<0.001) and isolation of M. tuberculosis in blood cultures (p= 0,025) were significantly more common among HIV-infected patients. Eighty seven HIV-positive and 98 HIV-negative patients used rifampicin until the end of TB therapy (p<0.001). At presentation, the mean CD4 cell count among HIV-infected patients was 170,13 cell/mm3 and the mean viral load was 4,94 log. There were 28 deaths among HIV infected subjects and 7 among HIV negative patients during follow-up (p<0.001). Deaths were associated with TB in 22 HIV-positive subjects and in 3 HIV-negative patients (p<0.001). TB-associated deaths were significantly more common in patients who had disseminated disease (p<0.001), positive blood cultures ( p=0.001) and who did not use rifampicin until the end of the therapy (p=0.002). Among HIV infected subjects, treatment with HAART was associated with a lower risk of TB-associated death (p=0.001). However, a subgroup analysis showed that mortality among HIV-infected patients treated with HAART was still significantly higher compared with mortality among HIV-negative patients (p=0.011).
Conclusion: These results suggest that despite the free access to HAART in Brazil, TB-associated mortality among patients who started anti-TB therapy is still significantly higher among HIV/TB co-infected subjects than among HIV negative patients.
Back to the session -
Back to the Programme-at-a-Glance
|
|