Mortality predictors among patients with HIV-associated pulmonary tuberculosis in Northeast China: A retrospective cohort analysis

The coexistence of pulmonary tuberculosis (PTB) and human immunodeficiency virus (HIV) infection leads to high morbidity and mortality in these populations. Although antiretroviral therapy (ART) has decreased TB incidence in HIV-infected patients, this coexistence still prevails in China. Patients with HIV-PTB admitted to Beijing You An Hospital from 2014 to 2018 were retrospectively enrolled, and information on demographics, clinical characteristics, and laboratory findings were extracted from medical records. Predictors of death, including age (adjusted hazard ratio [AHR]: 1.03; 95% confidence interval [CI]: 1.00-1.05), tobacco use (AHR: 2.76; 95% CI: 1.54-4.94), history of tuberculosis (AHR: 3.53; 95% CI: 1.82-6.85), not being on ART (AHR: 2.94; 95% CI: 1.31-6.63), extrapulmonary tuberculosis (AHR: 2.391; 95% CI: 1.37-4.18), sputum smear positivity (AHR: 2.84; 95% CI: 1.61-4.99), CD4(+) T cell count <= 50 cells/mu l (AHR: 3.45; 95% CI: 1.95-6.10), and initiating ART >= 8 weeks after the initiation of antituberculous therapy (odds ratio: 3.30; 95% CI: 1.09-10.04). By contrast, there were no deaths among the six patients who began ART within 8 weeks after the initiation of antituberculous therapy. Age, tobacco use, not being on ART, extrapulmonary tuberculosis, sputum smear positivity, and CD4(+) T cell count <= 50 cells/mu l predict those patients at high risk of death among HIV-infected patients with PTB, and the time of initiating ART after the initiation of antituberculous therapy is also important for prognosis.

Automated summary

Age, tobacco use, not being on ART, extrapulmonary tuberculosis, sputum smear positivity, CD4(+) T cell count <= 50 cells/mu l, and initiating ART >= 8 weeks after the initiation of antituberculous therapy are predictors of death among HIV-infected patients with PTB. Early initiation of ART within 8 weeks after the initiation of antituberculous therapy is associated with reduced mortality.