PROGRESSION OF HUMAN-IMMUNODEFICIENCY-VIRUS INFECTION IN PATIENTS WITH TUBERCULOSIS DISEASE

To assess the role of Mycobacterium tuberculosis disease in human immu nodeficiency virus (HIV) infection, the authors compared survival of t uberculosis patients and controls matched on year of HIV diagnosis and CD4+ lymphocyte count. Patients were selected in the Aquitaine Cohort , which follows, since 1985, all patients infected with HIV, aged more than 13 years, in five hospitals. Time of inclusion of controls was t he date of diagnosis of tuberculosis for the corresponding tuberculosi s patient. Patients who had received primary prophylaxis against mycob acteria other than tuberculosis were excluded. As of June 30, 1994, 10 4 tuberculosis patients and 620 controls were selected; they were simi lar, except for history of intravenous drug use (tuberculosis patients , 51%, vs. controls, 31%) and AIDS-defining opportunistic infection (4 0 vs. 29%). Survival was shorter in tuberculosis patients than in cont rols (risk ratio 1.5, 95% confidence interval 1.2-2.1) even after cont rolling for differences at entry. The risk of AIDS-defining opportunis tic infection or a decrease to fewer than 50 CD4+ cells/mm(3) was slig htly but not statistically greater in tuberculosis patients than in co ntrols. Tuberculosis disease affected survival but not occurrence of s ubsequent opportunistic infections or rate of CD4+ count decline. Tube rculosis may be a marker of advanced HIV and may accelerate its course of infection.