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2006, Number 2

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Rev Inst Nal Enf Resp Mex 2006; 19 (2)

Survival of 72 patients three years after the diagnosis of tuberculosis and AIDS in Cuba during the pre-HAART era

Reyes CA, Capó PV, Díaz JM, Pérez ÁJ, Bouza JY

Language: Spanish
References: 40
Page: 113-121
PDF size: 152.15 Kb.


ABSTRACT

Background: Infection due to HIV/AIDS affects more than 40 million people worldwide; around 20 million have succumbed since the epidemy began. There are higher mortality rates and shortened survival in those affected by tuberculosis (TB) and HIV-I. In Cuba, there are no previous studies regarding the survival of patients coinfected by HIV/TB.
Methods: Observational study of a series of 72 cases infected by TB and AIDS before the widespread use of highly active anti-retroviral therapy (HAART); we describe the clinical and immunological variables associated to three year survival from the diagnosis of TB/AIDS and to the risk of death. Survival analyses were done by the Kaplan-Meier method and the log-rank test to determine the survival function according to categories of the variables included. Cox’s proportional hazards was used to determine the independent association of each variable with the risk of death.
Results: 51.4% of patients were dead one year and 69.4%, three years after the diagnosis of TB. Mean CD4+T lymphocyte counts were significantly lower in the deceased, 126 cells/mm3 (p ‹ 0.0001); 44.4% fulfilled the criteria of death caused by TB. Mean survival was 10 months; survival was higher in those patients with TB as the first condition indicative of AIDS, in those who were not AIDS before TB, in those not having previous deep candidiasis, when CD4+T lymphocyte counts ≥ 200/mm3, in those with a reactive tuberculin skin test and when smears from sputum were negative to acid fast bacilli. The risk of death was independently associated to CD4+T lymphocyte counts ‹ 200/mm3, and having deep candidiasis before TB.
Conclusions: In the absence of HAART, opportunistic infections and immunologic impairment in patients with AIDS and TB are related to lower survival rates and increased risk of death.


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