AEGiS-13IAC: HIV as predictor of mortality in a cohort of tuberculosis patients in a semiurban community in Southern Mexico.

13th International AIDS Conference

Durban, South Africa - July 9-July 14, 2000

HIV as predictor of mortality in a cohort of tuberculosis patients in a semiurban community in Southern Mexico.

Int Conf AIDS 2000 Jul 9-14; 13:(abstract no. MoOrC190)

Garcia-Garcia ML, Eugenia Jimenez-Corona Ma, Ponce de Leon A, Sifuentes-Osornio J, Jimenez-Corona A, Valdespino-Gomez JL, Small P
M. L. Garcia-Garcia, Instituto Nacional de Salud Publica, Av. Universidad 655,, Col Sta. Ma. Ahuacatitlan, CP 62508, Mexico, Tel.: +52 73 175 529, Fax: +52 73 175 529, E-mail: garcigar@insp3.insp.mx

OBJECTIVE: To determine risk factors associated to mortality in a cohort of tuberculosis patients

METHODS: Since March, 1995 all persons in the Orizaba Health Jurisdiction (comprised of 134 square miles and 238,000 residents) with a cough persisting greater than 3 weeks have been evaluated with sputum microscopy. AFB positive persons were interviewed, examined and 3 sputa submitted for culture and drug susceptibility testing, HIV antibodies (ELISA and WB) have been performed on all participants. Anti-TB therapy was provided by the local control program. Annual visits for vital status were performed. Deaths were corroborated by death certificates. Informed consent was obtained from participants. Cox proportional hazards model was used to determine variables associated to all-cause-death.

RESULTS: 387 of 3608 (10.7%) persons with chronic cough were AFB smear positive, 331 were culture confirmed as M tuberculosis; 79 isolates were drug resistant, of these 25 resistant to both isoniazid and rifampin. Ten cases with HIV infection (3.5%) were diagnosed: 7 men, ages 22 to 62 years, eight from low socioeconomic status. Patients were followed for an average of 27.9 months. Fifty four deaths occurred during follow up. Cox-adjusted relative risks showed that HIV infection (31.3, 95%CI 11.6-84.8, p > 0.001) and drug resistance to isoniazid and rifampin (RR 2.5, 95%CI 1.02-6.16, p = 0.04) were associated to mortality controlling for age and chronicity of tuberculosis.

CONCLUSIONS: Although HIV prevalence in this community is low, HIV infection ranked first as predictor of mortality in this cohort of tuberculosis patients. It is important to revise treatment programs for these patients. (Partially funded by NIH grant number AI34969)

Keywords: AEGIS, Tuberculosis, Mycobacterium tuberculosis, HIV Infections, Prevalence, HIV Seropositivity, Risk Factors, Proportional Hazards Models, Sputum, Survival Rate, Mexico, Human, Male, mortality, Epidemiology
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