A PROSPECTIVE-STUDY OF TUBERCULOSIS AND HIV DISEASE PROGRESSION

Objective: To determine whether active tuberculosis alters the rate of progression of HIV infection in dually infected patients. Methods: HI V-seropositive patients at two Bronx, New York hospitals with tubercul osis confirmed by culture from July 1992 to February 1995, who survive d the initial hospitalization for tuberculosis, were matched on gender , age, CD4(+) percentage, and calendar time with HIV-seropositive pati ents without tuberculosis participating in a study of the natural hist ory of HIV infection. Patients received follow-up observation prospect ively until May 23, 1995 to determine survival rates and development o f AIDS-defining opportunistic infections (OIs). Results: 70 patients h ad tuberculosis; 120 did not. Mean CD4+ percentages were 12.4% and 12. 5%, respectively. At study entry, 27% of those with tuberculosis had p rior AIDS-defining OIs other than tuberculosis, compared with 10% of t hose without tuberculosis (p = .004). In multivariate survival analysi s, controlling for CD4+ level, tuberculosis was not an independent pre dictor of increased other causes of AIDS-related mortality. However, i n a logistic regression model, independent predictors of subsequent OI s included tuberculosis (hazard ratio, 4.1; 95% confidence intervals [ CI], 1.9, 8.7), CD4(+) count <100/mm(3) (hazard ratio, 2.4; 95% CI, 1. 1, 5.0) and prior OIs (hazard ration, 3.3; 95% CI, 1.3, 8.3). Conclusi ons: Tuberculosis was not an independent predictor of increased nontub erculosis-related mortality in HIV-seropositive patients but was assoc iated with increased risk of development of OIs.