A PROSPECTIVE-STUDY OF TUBERCULOSIS AND HUMAN-IMMUNODEFICIENCY-VIRUS INFECTION - CLINICAL MANIFESTATIONS AND FACTORS ASSOCIATED WITH SURVIVAL

We prospectively studied the effect of human immunodeficiency virus (H IV) infection on the presentation and outcome of tuberculosis, A total of 216 patients with tuberculosis were identified; 162 (75%) of these patients were tested for antibodies to HIV; 92 (57%) were seropositiv e. The patients who were seropositive for HIV were more likely to be m ale and Hispanic and to have been homeless or incarcerated. Eighty-one percent of these patients had CD4 lymphocyte counts of less than or e qual to 200/mm(3). The seropositive patients had extrapulmonary tuberc ulosis more often than did the seronegative patients (odds ratio [OR], 2.3; 95% confidence interval [Cl], 1.2-4.8). Smears for acid-fast bac illi were positive more often for non-HIV-infected patients with pulmo nary tuberculosis (74.5%) than for HIV-infected patients (54.3%) [OR, 2.46; 95% Cl, 1.01-6.02]-even those with focal or cavitary disease. A delay in initiating therapy was associated with in-hospital mortality: the median time from admission to the start of treatment was 4 days f or patients who survived and 15 days for those who died (P = .02). The median survival was 22.7 months for HIV-infected patients who did not die during the initial hospitalization. Factors independently associa ted with reduced rates of survival included the severity of immunodefi ciency, nonuse of directly observed therapy, infection due to drug-res istant Mycobacterium tuberculosis, and a history of injection drug use .