Slightly more than 10% in a Rio de Janeiro cohort with newly diagnosed HIV infection already had tuberculosis, according to results of a 4500-person study. Although antiretroviral therapy (ART) started faster in the people with than without TB, those with TB had almost a 75% higher early death risk.
Brazil has a well-established HIV program including free ART, but late HIV diagnosis remains a problem. Because late diagnosis raises chances of concurrent TB, researchers conducted this analysis of HIV-positive people enrolled in the TB/HIV in Rio (THRio) cohort between 1 September 2005 and 31 August 2009.
Study goals were to calculate TB prevalence at HIV diagnosis, to determine how quickly people with and without TB started ART, and to estimate differences in early mortality. The THRio team defined prevalent TB as (1) TB diagnosis within 60 days of HIV diagnosis or (2) HIV diagnosis during TB therapy. They used Kaplan-Meier analysis to determine survival and Cox regression to compare survival between the TB group and the no-TB group.
The study included 4548 people with newly diagnosed HIV, 476 (10.5%) of whom had prevalent TB. People with prevalent TB were older, had lower CD4 counts, and had higher viral loads than people without TB.
Median time to starting ART measured 99 days (interquartile range [IQR] 58 to 191) in people with prevalent TB and 126 days (IQR 63 to 301) in those without TB (P = 0.021).
Mortality during follow-up stood at 17% in people with prevalent TB versus 8% in those without TB, a highly significant difference (P < 0.001). After statistical adjustment for age, gender, and pre-ART CD4 count and viral load, people with prevalent TB had almost a 75% higher risk of death (hazard ratio 1.72, 95% confidence interval 1.19 to 2.48).
The researchers conclude that “earlier HIV diagnosis is necessary to provide earlier initiation of [ART] and TB preventive therapy to reduce morbidity and mortality in people living with HIV.”
Source: Valeria Saraceni, Silvia Cohn, Solange C. Cavalcante, Antonio G.F. Pacheco, Lawrence H. Moulton, Richard E. Chaisson, Betina Durovni, Jonathan E. Golub. Prevalent tuberculosis at HIV diagnosis in Rio de Janeiro, Brazil: the TB/HIV in Rio (THRio) cohort. JAIDS. 2014; 67: 98-101.
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