Timely, combined treatment key in patients with HIV/TB coinfection

Worodria W. J Acquir Immune Defic Syndr. 2011;58:32-37.

Issue: September 2011

Patients coinfected with HIV and tuberculosis who presented with advanced HIV disease and did not initiate antiretroviral therapy were at increased risk for mortality. Therefore, William Worodria, MMed, and colleagues recommend for timely initiation of treatment for both infections.

“Screening for a concomitant cryptococcal infection and antifungal treatment for patients with cryptococcal antigenemia may further improve clinical outcome,” the researchers wrote in the study.

Worodria, of the department of medicine at Mulago Hospital in Uganda, and colleagues used Cox proportional hazards analysis to assess the incidence and predictors of early mortality among HIV/TB coinfected patients initiating ART for the first time (n=302). Patients had a median CD4 count of 53 cells/mcL.

Of the 53 deaths that occurred, 68% died within the first 6 months of TB diagnosis.

Multivariate analysis revealed independent predictors of mortality were male sex (HR=2.19; 95% CI, 1.19-4.03); anergy to TB skin test (HR=2.59; 95% CI, 1.10-6.12); a positive serum cryptococcal antigen result at baseline (HR=4.27; 95% CI, 1.50-12.13); and no ART use (HR=4.63; 95% CI, 2.37-9.03), according to the study.

An additional 10% of patients with TB immune reconstitution inflammatory syndrome died due to alternative contributing causes.

Disclosure: The researchers report no relevant financial disclosures.

This study makes an important contribution by identifying predictors of death in patients with TB-HIV co-infection. These predictors can be used as the basis for future interventions to reduce mortality in co-infected patients.

- Salim Abdool Karim, MD, PhD

University of KwaZulu-Natal and Columbia University

Disclosure: Dr. Karim reports no relevant financial disclosures.

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