Constantza is an endemic area of tuberculosis (TB) and a prevalent region for HIV/AIDS in Romania. Few studies examined the impact of active TB on the survival of HIV infected persons.
Between 1989 and 2006, all patients presenting medical recordings of HIV-1 infection +/− TB disease were retrospectively reviewed. Survival was analyzed with Kaplan Meier method and Cox proportional hazard model (confidence interval = 95%) exploring two groups of HIV-1 seropositive individuals (with or without active TB disease).
Of the 771 reported HIV-1 cases from January 1989 to December 2006, 527 (68.35%) had available medical files. 268 of these (50.85%), mean aged 13.14 +/− 14.32 yrs, developed TB. Overall mortality rate was greater in TB group (104/268 or 38.8%) versus those without TB (26/259 or 10.03%; OR = 3.87; 2.38 < OR < 6.31; RR = 3.06; 2.05 < RR < 4.85; chi2 = 36.01; p < 0.0001) (n = 130 with mortality data, mean aged 16.2 +/− 16.89 yrs). 70% of the deaths were reported till the end of 1996 (n = 91/130)when anti-retroviral therapy was not routinely available. Mean survival times was greater in those with TB (85.721 +/− 4.602 months versus 50.085 +/− 2.176). In this group, patients had a median survival of 57.0 +/− 6.736 months, as compared to 43.0 +/− 3.336 months for HIV without TB. Survival between HIV patients with different forms of TB disease was similar for those with pulmonary and extrapulmonary TB (29.881 +/− 6.529 months; 30.250 +/− 4.904 months), being greater compared to severe disseminative TB (11.300 +/− 1.882 months; Kaplan Meier log rank chi2 = 146.964, p < 0.0001).
TB disease, especially disseminated forms, affectes survival outcomes among HIV-1 infected persons. These results seem to underscore the importance of therapy for TB in prolonging survival among HIV infected patients.
Both routine screening and preventive therapy for TB are important in prolonging survival among HIV infected patients in countries where HIV and TB are endemic and where anti-retroviral therapy is not routinely available.
Oana Arghir, No Financial Disclosure Information; No Product/Research Disclosure Information