1652. Highly Active Antiretroviral Therapy Improves Survival of HIV-infected Tuberculosis Patients with preserved immunity
Session: Poster Abstract Session: Mycobacterial Infections
Saturday, October 5, 2013
Room: The Moscone Center: Poster Hall C
Background:

Tuberculosis (TB) is a leading cause of mortality among HIV-infected individuals. The WHO recommends HAART for all HIV-infected persons with TB, regardless of the CD4+ T cell count. Although the evidence for the benefit of HAART in HIV-infected TB patients with advanced immunosuppression is strong, optimal management is uncertain for TB patients with CD4+ counts above 350 cells/mm³. The objective of this analysis was to determine whether HAART improved survival among TB patients with CD4+ count ≥ 350 cells/mm³.

Methods:

We enrolled 345 subjects with CD4+ count ≥ 350 cells/mm³ in a retrospective cohort study of HIV-infected patients with TB who received TB therapy between 2006 and 2012 in southern Zambia. Survival distributions were compared between patients who received HAART during TB therapy and patients who did not receive HAART. The primary end point was death from any cause. Mortality rates were estimated using Kaplan-Meier methods and compared with the log-rank test; Cox proportional hazards analysis and propensity score analysis were done to control for potential confounders (e.g., age, sex, co-trimoxazole use, performance status; confounding by indication).

Results:

Patients started on HAART (N=252) were similar to patients not started on HAART (N=82) except for proportion women (59% vs 47%), CD4+ count 350 – 499 cells (59% vs 47%), and co-trimoxizole use (71% vs 22%). Of patients on HAART, 21 died (8%) and 18 (7%) were lost to follow-up; of patients not on HAART, 20 died (25%) and 20 (25%) were lost to follow-up. Patients receiving HAART had a better 2-year survival compared with those not started on HAART (92% vs. 75%; P = 0.000, log-rank test). In a proportional hazard regression model, the risk of death was reduced with HAART by 78% (HR = 0.22; 95% CI:0.09, 0.53) controlling for sex, CD4+ count, and cotrimoxazole use. In a propensity score analysis, the effect of HAARTwas attenuated but remained beneficial (HR = 0.37; 95% CI:0.15, 0.93).

Conclusion:

In HIV-infected patients with TB and CD4+ count ≥ 350 cells/mm³, starting HAART during TB therapy was associated with improved survival over 2 years.

Christopher Whalen, MD, MS, Epidemiology and Biostatistics, University of Georgia College of Public Health, Athens, GA and Simon Mutembo, MBChB, Ministry of Health, Livingstone, Zambia

Disclosures:

C. Whalen, None

S. Mutembo, None

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