American Journal of Epidemiology Advance Access originally published online on March 5, 2007
American Journal of Epidemiology 2007 165(10):1134-1142; doi:10.1093/aje/kwk116
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ORIGINAL CONTRIBUTIONS |
Effect of Tuberculosis on the Survival of Women Infected with Human Immunodeficiency Virus
1 Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
2 Dirección de Medicina, Instituto Nacional de Ciencias Médicas y Nutrición, Salvador Zubirán, México D.F., México
3 Department of Medicine, University of California, San Francisco, San Francisco, CA
4 CORE Center/Stroger Hospital of Cook County, Chicago, IL
5 SUNY Downstate Medical Center, State University of New York, Brooklyn, NY
6 Department of Preventive Medicine, School of Medicine, University of Southern California, Los Angeles, CA
7 Lincoln Medical and Mental Health Center, Bronx, NY
Reprint requests to Dr. Hugo López-Gatell, Dirección de Medicina, Instituto Nacional de Ciencias Médicas y Nutrición, Salvador Zubirán, Vasco de Quiroga 15, Tlalpan C.P. 14000, México D.F., México (e-mail: hlgatell{at}jhsph.edu).
Received for publication May 2, 2006. Accepted for publication October 26, 2006.
Evidence regarding the effect of tuberculosis (TB) disease on progression of human immunodeficiency virus (HIV) disease is inconclusive. The authors estimated the effect of time-varying incident TB on time to acquired immunodeficiency syndrome (AIDS)-related mortality using a joint marginal structural Cox model. Between 1995 and 2002, 1,412 HIV type 1 (HIV-1)-infected women enrolled in the Women's Interagency HIV Study were followed for a median of 6 years. Twenty-nine women incurred incident TB, and 222 died of AIDS-related causes. Accounting for age, CD4 cell count, HIV-1 RNA level, serum albumin level, and non-TB AIDS at study entry, as well as for time-varying CD4 cell count, CD4 cell count nadir, HIV-1 RNA level, peak HIV-1 RNA level, serum albumin level, HIV-related symptoms, non-TB AIDS, anti-Pneumocystis jiroveci prophylaxis, antiretroviral therapy, and household income, the hazard ratio for AIDS-related death comparing time after incident TB with time before incident TB was 4.0 (95% confidence interval (CI): 1.2, 14). The effect of incident TB on mortality was similar among highly active antiretroviral therapy (HAART)-exposed women (hazard ratio = 4.3, 95% CI: 0.9, 22) and non-HAART-exposed women (hazard ratio = 3.9, 95% CI: 0.9, 17; interaction p = 0.91). Although results were imprecise because few women incurred TB, irrespective of HAART exposure, incident TB increases the hazard of AIDS-related death among HIV-infected women.
acquired immunodeficiency syndrome; causality; disease progression; HIV infections; models, statistical; survival analysis; tuberculosis; women
Abbreviations: AIDS, acquired immunodeficiency syndrome; CI, confidence interval; HAART, highly active antiretroviral therapy; HIV, human immunodeficiency virus; HR, hazard ratio; PCP, Pneumocystis jiroveci pneumonia; TB, tuberculosis; WIHS, Women's Interagency HIV Study
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