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Clinical and Developmental Immunology
Volume 2012 (2012), Article ID 931325, 8 pages
http://dx.doi.org/10.1155/2012/931325
Clinical Study

Impact of Previous ART and of ART Initiation on Outcome of HIV-Associated Tuberculosis

1Clinical Epidemiology Unit, Department of Epidemiology and Clinical Department, National Institute for Infectious Diseases L. Spallanzani, Via Portuense 292, 00149 Rome, Italy
2Institute of Infectious and Tropical Diseases, University of Brescia, 25123 Brescia, Italy
3Division of Infectious Diseases, Department of Internal Medicine, “San Gerardo” Hospital, University of Milano-Bicocca, 20900 Monza, Italy
4Clinic of Infectious Diseases, University of Bari, 70124 Bari, Italy

Received 1 September 2011; Revised 5 January 2012; Accepted 12 January 2012

Academic Editor: Graeme Meintjes

Copyright © 2012 Enrico Girardi et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background. Combination antiretroviral therapy (cART) has progressively decreased mortality of HIV-associated tuberculosis .To date, however, limited data on tuberculosis treatment outcomes among coinfected patients who are not ART-naive at the time of tuberculosis diagnosis are available. Methods. A multicenter, observational study enrolled 246 HIV-infected patients diagnosed with tuberculosis, in 96 Italian infectious diseases hospital units, who started tuberculosis treatment. A polytomous logistic regression model was used to identify baseline factors associated with the outcome. A Poisson regression model was used to explain the effect of ART during tuberculosis treatment on mortality, as a time-varying covariate, adjusting for baseline characteristics. Results. Outcomes of tuberculosis treatment were as follows: 130 (52.8%) were successfully treated, 36 (14.6%) patients died in a median time of 2 months (range: 0–16), and 80 (32.6%) had an unsuccessful outcome. Being foreign born or injecting drug users was associated with unsuccessful outcomes. In multivariable Poisson regression, cART during tuberculosis treatment decreased the risk of death, while this risk increased for those who were not ART-naive at tuberculosis diagnosis. Conclusions. ART during tuberculosis treatment is associated with a substantial reduction of death rate among HIV-infected patients. However, patients who are not ART-naive when they develop tuberculosis remain at elevated risk of death.