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Multicenter Study
. 2012:2012:931325.
doi: 10.1155/2012/931325. Epub 2012 Mar 22.

Impact of previous ART and of ART initiation on outcome of HIV-associated tuberculosis

Enrico Girardi  1 , Fabrizio Palmieri, Claudio Angeletti, Paola Vanacore, Alberto Matteelli, Andrea Gori, Sergio Carbonara, Giuseppe Ippolito
Affiliations
Multicenter Study

Impact of previous ART and of ART initiation on outcome of HIV-associated tuberculosis

Enrico Girardi et al. Clin Dev Immunol. 2012.

Abstract

Background: Combination antiretroviral therapy (cART) has progressively decreased mortality of HIV-associated tuberculosis .To date, however, limited data on tuberculosis treatment outcomes among coinfected patients who are not ART-naive at the time of tuberculosis diagnosis are available.

Methods: A multicenter, observational study enrolled 246 HIV-infected patients diagnosed with tuberculosis, in 96 Italian infectious diseases hospital units, who started tuberculosis treatment. A polytomous logistic regression model was used to identify baseline factors associated with the outcome. A Poisson regression model was used to explain the effect of ART during tuberculosis treatment on mortality, as a time-varying covariate, adjusting for baseline characteristics.

Results: Outcomes of tuberculosis treatment were as follows: 130 (52.8%) were successfully treated, 36 (14.6%) patients died in a median time of 2 months (range: 0-16), and 80 (32.6%) had an unsuccessful outcome. Being foreign born or injecting drug users was associated with unsuccessful outcomes. In multivariable Poisson regression, cART during tuberculosis treatment decreased the risk of death, while this risk increased for those who were not ART-naive at tuberculosis diagnosis.

Conclusions: ART during tuberculosis treatment is associated with a substantial reduction of death rate among HIV-infected patients. However, patients who are not ART-naive when they develop tuberculosis remain at elevated risk of death.

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