Tuberculosis,
HAART, and Survival in the THRio Cohort in Rio de Janerio, Brazil
 By
Liz Highleyman
Tuberculosis
(TB) is a major cause of morbidity and mortality among people
with HIV/AIDS worldwide. Yet the best time to initiate HAART
after a diagnosis of TB in HIV positive individuals remains unclear. The
aim of the current study, presented at the XVII International
AIDS Conference (AIDS 2008) this month in Mexico City, was to compare survival
after a TB diagnosis, comparing use of HAART and -- among those who initiated
antiretroviral therapy -- the
timing of treatment.  | A
San Francisco health official takes care of Tubgerculosis (TB) patient, Ryan.
SF Chronicle. |
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The
TRHio cohort in Rio de Janerio, Brazil includes 15,426 HIV patients receiving
care at 29 public clinics. Participants in the study included those who were HAART-naive
at the time of a new TB diagnosis between September 2003 and June 2006. Survival
was measured in days from diagnosis of TB. Data were compared as follows: HAART
after TB diagnosis versus no HAART, HAART during TB treatment versus HAART after
TB treatment, and HAART initiated during the first 60 days after TB diagnosis
compared to 61-80 days or more than 180 days after diagnosis. Results
•
Overall, 963
patients had a TB diagnosis, 632 of whom were HAART-naive and 459 of whom initiated
antiretroviral therapy.
•
Men comprised
66% of the cohort and the median age was 36 years.
•
A total of
85 of the 632 HAART-naive patients (13%) died during follow-up.
•
Patients who
started HAART after a TB diagnosis had a significantly lower risk of death than
those who did not receive HAART (9% vs 25%; P < 0.001).
•
76% of patients
who survived received HAART, compared with 49% of those who died (P < 0.001).
•
After controlling
for HAART use, patients who completed TB treatment were also less likely to die.
•
81% of patients
who survived finished TB treatment, compared with 32% of those who died (P <
0.001).
•
The timing
of HAART -- during or after TB treatment -- was not significantly associated with
better or worse survival (P = 0.313).
•
Survival analysis
did not show a significant difference regarding time to HAART initiation after
TB diagnosis (death rates of 7% for <60 days, 11% for 60-180, and 10% for >180
days; P = 0.405).
•
Pre-treatment
CD4 cell counts were similar in TB patients who died and those who survived (164
vs 183 cells/mm3, respectively; P = 0.871).
 | The
Mantoux skin test consists of an intradermal injection of exactly one tenth of
a milliliter (mL) of PPD tuberculin. |
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Based
on these findings, the investigators concluded, "HAART exposure was significantly
related to improved survival after TB diagnosis," despite lower median CD4
counts among those who received HAART compared with those who did not. They
continued, "Time of initiation of HAART not associated with significant changes
in survival," but added, "Delays in diagnosis [of] HIV in TB patients
[is] associated with lower likelihood of receiving HAART." Rio
de Janiero City Health Secretariat, Rio de Janiero, Brazil; Johns Hopkins University
School of Medicine, Center for Tuberculosis Research, Baltimore, MD; FIOCRUZ,
DEMQS, Rio de Janiero, Brazil; Johns Hopkins University School of Medicine, Johns
Hopkins HIV Clinic, Baltimore, MD. 8/26/08 Reference V
Saraceni, BS King, AGF Pacheco, and others. Tuberculosis, HAART Use and Survival
in the THRio Cohort, Rio de Janerio, Brazil. XVII International AIDS Conference
(AIDS 2008). Mexico City. August 3-8, 2008. Abstract
MOAB0305. |
