PREDICTORS OF SURVIVAL IN HUMAN IMMUNODEFICIENCY VIRUS-INFECTED PATIENTS WITH PULMONARY TUBERCULOSIS

Infection with the human immunodeficiency virus (HIV) has changed both the epidemiology and natural history of tuberculosis. Despite a gener ally good response to effective antituberculous therapy, the prognosis remains poor. The objective of this analysis was to determine the ind ependent predictors of survival in HIV-infected Ugandan adults with sm ear-positive pulmonary tuberculosis. A total of 191 HIV-infected Ugand an adults with smear-positive pulmonary tuberculosis were enrolled int o a clinical trial of chemotherapy for tuberculosis. The subjects rece ived either rifampin, isoniazid, and pyrazinamide for two months, foll owed by rifampin and isoniazid for six months (n = 101) or streptomyci n, thiacetazone, and isoniazid for two months followed by thiacetazone and isoniazid for eight months (n = 90). After standard measurements were made at baseline, the group was followed at regular intervals for a mean of 16 months to determine survival. During the course of follo w-up, 82 (43%) of the patients died, six within the first month of the rapy. The one-year survival proportion was 68% with an estimated media n survival of 26 months and did not differ according to treatment regi men. The hazard for death was biphasic, high early in the course of th erapy, and then again after about one year. After controlling for the treatment regimen, four independent predictors of survival were found: anergy to purified protein derivative, atypical chest roentgenogram, previous HIV-related condition, and lymphopenia. In this cohort of Uga ndan adults, four simple and inexpensive predictors of survival were f ound. These factors suggest that the degree of immunosuppression was a major determinant of survival.