Journal
AMERICAN JOURNAL OF EPIDEMIOLOGY
Volume 165, Issue 10, Pages 1134-1142Publisher
OXFORD UNIV PRESS INC
DOI: 10.1093/aje/kwk116
Keywords
acquired immunodeficiency syndrome; causality; disease progression; HIV infections; models; statistical; survival analysis; tuberculosis; women
Categories
Funding
- NCRR NIH HHS [M01-RR-00079, M01-RR-00083, M01-RR-00071] Funding Source: Medline
- NIAID NIH HHS [U01-AI-35004, U01-AI-42590, U01-AI-31834, U01-AI-34989, U01-AI-34993, U01-AI-34994] Funding Source: Medline
- NICHD NIH HHS [U01-HD-32632] Funding Source: Medline
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Evidence regarding the effect of tuberculosis (TB) disease on progression of human immunodeficiency virus (HIV) disease is inconclusive. The authors estimated the effect of time-varying incident TB on time to acquired immunodeficiency syndrome (AIDS)-related mortality using a joint marginal structural Cox model. Between 1995 and 2002, 1,412 HIV type 1 (HIV-1)-infected women enrolled in the Women's Interagency HIV Study were followed for a median of 6 years. Twenty-nine women incurred incident TB, and 222 died of AIDS-related causes. Accounting for age, CD4 cell count, HIV-1 RNA level, serum albumin level, and non-TB AIDS at study entry, as well as for time-varying CD4 cell count, CD4 cell count nadir, HIV-1 RNA level, peak HIV-1 RNA level, serum albumin level, HIV-related symptoms, non-TB AIDS, anti-Pneumocystis jiroveci prophylaxis, antiretroviral therapy, and household income, the hazard ratio for AIDS-related death comparing time after incident TB with time before incident TB was 4.0 (95% confidence interval (CI): 1.2, 14). The effect of incident TB on mortality was similar among highly active antiretroviral therapy (HAART)-exposed women (hazard ratio = 4.3, 95% CI: 0.9, 22) and non-HAART-exposed women (hazard ratio = 3.9, 95% CI: 0.9, 17; interaction p = 0.91). Although results were imprecise because few women incurred TB, irrespective of HAART exposure, incident TB increases the hazard of AIDS-related death among HIV-infected women.
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