Journal
AIDS
Volume 22, Issue 14, Pages 1869-1873Publisher
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/QAD.0b013e32830e010c
Keywords
models; mortality; Multicenter AIDS Cohort Study; opportunistic infections; tuberculosis
Categories
Funding
- NCRR NIH HHS [M01 RR000722, M01 RR000722-23, 5-MO1-RR-00722] Funding Source: Medline
- NIAID NIH HHS [U01 AI035042-16, U01 AI035043, UO1-AI-35043, U01 AI035043-19, U01 AI035040, U01 AI037613-08, UO1-AI-37984, U01 AI037984-08, UO1-AI-35040, U01 AI035042, UO1-AI-37613, U01 AI035041-17, UO1-AI-35042, U01 AI037984, U01 AI035039-17, U01 AI035039, U01 AI035040-19, U01 AI035041, UO1-AI-35041, U01 AI037613, UO1-AI-35039] Funding Source: Medline
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Background: Evidence regarding the effect of tuberculosis (TB) on HIV disease progression at the population level remains inconclusive. Method: We estimated the effect of incident TB on time to AIDS-related death, using a marginal structural Cox model. Results: Between 1984 and 2005, 2882 HIV-infected men in the Multicenter AIDS Cohort Study contributed 21 914 person-years while followed for a median of 5.4 years. At Study entry, the median CD4 cell Count and HIV-1 RNA viral load were 533 cells/mu l (interquartile range: 365-737) and 12953 copies/ml (interquartile range: 245348540), respectively. This study was performed in a setting with a modest exposure to HAART; 8295 of 23 801 (35%) person-years were followed during the HAART era. Fifteen men incurred incident TB, yielding a TB incidence of 7 (95% confidence interval: 4-14) per 10000 person-years and 1072 died of AIDS-related causes. Accounting for potential confounders, including CD4 cell count and viral load, the hazard of AIDS-related death was 2.4 times more for the person-time with TB compared to the person-time without TB (95% confidence interval: 1.2-4.7). Conclusion: Results underscore the importance of avoiding TB by using preventive interventions Such as treatment of latent TB infection, particularly in Populations with a large prevalence of HIV/TB co-infected individuals. (C) 2008 Wolters Kluwer Health vertical bar Lippincott Williams & Wilkins.
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