17th International AIDS Conference Mexico City, Mexico - August 13 - 18, 2008

TUBERCULOSIS, HAART USE AND SURVIVAL IN THE THRio COHORT, RIO DE JANEIRO, BRAZIL

Int Conf AIDS. 2008 Aug 13-18;17 Abstract No. MOAB0305

V. Saraceni ¹, B.S. King², A.G.F. Pacheco³, J.E. Golub², S.C. Cavalcante¹, L.H. Moulton⁴, R.D. Moore⁵, R.E. Chaisson², B. Durovni^1
1Rio de Janeiro City Health Secretariat, Rio de Janeiro, Brazil, ²Johns Hopkins University School of Medicine, Center for Tuberculosis Research, Baltimore, United States, ³FIOCRUZ, DEMQS, Rio de Janeiro, Brazil, ⁴Johns Hopkins Bloomberg School of Public Health, International Health, Baltimore, United States, ⁵Johns Hopkins University School of Medicine, Johns Hopkins HIV Clinic, Baltimore, United States

BACKGROUND: Questions remain about the best time to initiate HAART after a tuberculosis (TB) diagnosis in HIV-infected patients. Our objective was to compare survival after a TB diagnosis, comparing exposure to HAART and, among those who initiated HAART, the timing of treatment.

METHODS: The THRio cohort includes 15,006 patients receiving HIV care in public clinics. Patients who were HAART-naïve at the time of a new TB diagnosis between 01 Sep 2003 and 30 Jun 2006 were included. Survival was measured in days from diagnosis of TB. Right censoring was done at the last note on the chart, up to 31 Dec 2006. Data were compared as follows: HAART after TB diagnosis versus no HAART, HAART during TB treatment versus HAART after TB treatment, and HAART initiated in the first 60 days compared to HAART started days 61-180 and >180 days. Kaplan-Meier plots and Cox regression analyses were conducted.

RESULTS: There were 660 patients with a TB diagnosis in the study period, 461 of whom initiated HAART. Men comprised 66% of the cohort. Patients who started HAART after a TB diagnosis had a significantly lower risk of death than those with no HAART use [p<0.001, log rank test; aHR=0.30 (95% CI 0.19-0.47)], and those who completed TB treatment, after controlling for HAART use, were also less likely to die [aHR=0.13 (CI 95% 0.08-0.21)]. The timing of HAART (started during or after TB treatment) was not associated with survival (p=0.313, log-rank test). Survival analysis did not show any difference regarding categories of time to HAART initiation (<60, 60-180, >180 after TB diagnosis; p=0.405, log rank test).

CONCLUSIONS: HAART use was related to improved survival after a TB diagnosis, with the effect being greater when combined with completion of TB treatment. The timing of introduction of HAART was not associated with significant changes in survival.

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2008-08-13
MOAB0305

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