Girardi E, Zinzi D, Ippolito G, Ammassari A, Palmieri F, Cingolani A, Antinori A, Gillini L; International Conference on AIDS.

Int Conf AIDS. 2000 Jul 9-14; 13: abstract no. TuPeB3149.

E. Girardi, IRCCS, Via Portuense, 292, 00149 Rome, Italy, Tel.: +39 6559 4223, Fax: +39 6559 4224, E-mail: craids@tiscalinet.it

Background: The objective of this study was to assess changes in clinical presentation and outcome of HIV-associated tuberculosis (TB) before and after widespread implementation of highly active antiretroviral therapy (HAART). Methods: We reviewed clinical charts of HIV infected patients with culture-confirmed pulmonary TB in two referral clinical centers in Rome, Italy. 67 patients diagnosed in 95-96 were compared to 51 patients diagnosed in 97-98. To analyze factors associated with survival we used a Cox model including antiretroviral therapy as a time-dependent covariate. Results: Patients diagnosed in 97-98 were more likely to have TB as the first AIDS defining illness (78% vs 58%, p>0.03), to have HIV diagnosed less than two months before TB (33% vs 7%, p > 0.01) and to have "typical" chest X-ray pattern (43% vs 25%, p > 0.05), and had a higher CD4+ count (median 104 vs 43, p > 0.01). Survival at one year was 78% for patients diagnosed in 97-98 vs 65% for those diagnosed in 95-96. In univariate analysis survival was significantly higher for patients diagnosed in 97-98 (p > 0.05, log-rank). In multivariate analysis, after adjusting for previous opportunistic infections, CD4+ count, sex, and presence of extrapulmonary disease, period of diagnosis was no longer associated with survival (HR 0.96; 95% CI, 0.44-2.10) while triple combination antiretroviral therapy was associated with a decreased risk of death (HR 0.27; 95% CI, 0.09-0.81). Conclusions: Cases of HIV-associated TB occurring in patients with advanced immunosuppression and presenting with "atypical" radiological appearance tends to be relatively less common in the HAART era. HAART is a major factor in prolonging survival of these patients.

Publication Types:

• Meeting Abstracts

Keywords:

• Acquired Immunodeficiency Syndrome
• Antiretroviral Therapy, Highly Active
• CD4 Lymphocyte Count
• HIV Infections
• HIV Seropositivity
• Health Personnel
• Humans
• Italy
• Proportional Hazards Models
• Rome
• Survival
• Tuberculosis
• Tuberculosis, Pulmonary

Other ID:

• GWAIDS0001568

UI: 102239059

From Meeting Abstracts