Influence of HIV Infection on Mortality in a Cohort of Patients Treated for Tuberculosis in the Context of Wide Access to HAART, in Rio de Janeiro, Brazil

Objective: To analyze the influence of HIV serostatus on mortality related to tuberculosis (TB) in the context of wide access to highly active antiretroviral therapy (HAART) in a middle-income country. Methods: Prospective cohort study including patients who started antituberculous therapy between April 2000 and July 2005 at a referral center in Rio de Janeiro, Brazil. Results: Two hundred seven patients were enrolled, 106 were seropositive for HIV There were 21 TB-related deaths in HIV positive subjects (24.7 deaths per 100 patient-years) and 2 (2.5 deaths per 100 patient-years) among HIV negative patients (rate ratio = 9.76, P < 0.001). Among HIV infected subjects, TB-related mortality tended to be lower in patients treated with HAART [hazard ratio (HR) = 0.58, P = 0.06]. However, mortality among patients treated with HAART was still significantly increased as compared with HIV negative patients (HR = 6.6, P = 0.014). In a Cox regression model adjusted for disseminated TB (P = 0.04), and treatment with antituberculous regimens not containing rifampicin (P = 0.11), mortality was significantly higher among seropositive patients not on HAART compared with HIV negative subjects (HR = 6.30, P = 0.024). Among subjects treated with HAART, there was a nonsignificant increase in mortality (rate ratio = 3.48, P = 0.14). Conclusions: HIV infection still has a substantial impact on TB-related mortality in the context of wide access to HAART in a middle-income country.