4th International AIDS Society Conference on HIV Pathogenesis and Treatment


Sydney, Australia - July 22 - 25, 2007

MORTALITY ASSOCIATED WITH TUBERCULOSIS IN HIV POSITIVE AND NEGATIVE PATIENTS IN THE HAART ERA, IN RIO DE JANEIRO, BRAZIL

IAS Conf HIV Pathog Treat 2007 Jul 22-25;4th: Abstract No. MOAB105

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).

CONCLUSIONS: 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.

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2007-07-22
MOAB105
TB / HIV: Still a Deadly Partnership

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