Factors Associated with Survival Among Adults with HIV-Associated TB in Guangxi, China: A Retrospective Cohort Study

Abstract

Aim: Although China has the second highest burden of TB in the world and faces a burgeoning HIV epidemic, the epidemiology and 12-month clinical outcomes of HIV-infected TB patients have not previously been reported. Methods: We reviewed records of all HIV-infected adults diagnosed with culture-confirmed TB from four HIV clinics in Guangxi, China from August 2006 to December 2008. Factors associated with patients‘ survival within 12 months after TB diagnosis were evaluated in Cox proportional hazards models. Results: Among the 201 patients included, 47 (23%) died within 12 months. Median CD4 count at TB diagnosis was 37 cells/mm³ (interquartile range: 16–102). Receiving HAART (adjusted hazard ratio [AHR]: 4.2; 95% CI: 1.6–10.8), receiving TB treatment (AHR: 9.0; 95% CI: 1.5–53.5) and baseline BMI ≥ 18.5 (AHR: 8.4; 95% CI: 1.9–35.8) were independently associated with survival. Among 171 (85%) patients who received TB treatment, receiving HAART (HR: 5.1; 95% CI: 2.4–10.7) was the only factor significantly associated with survival. Conclusion: HIV-infected Chinese patients diagnosed with TB in Guangxi are at high risk of death within 12 months, a risk that is strongly mitigated by antiretroviral therapy. Improving survival from HIV-associated TB in China will require the integration of TB and HIV programs to improve access to treatment for both diseases.

Keywords:

• HAART
• HIV
• survival
• tuberculosis

Authors‘ contributions

Y Zhang, L Yu, K Sun and F Zhang designed the study. Y Zhang, K Sun, Z Tang, S Huang, Z Meng and Y Zheng collected the data. Y Wen, H Zhu, L Yu analyzed the data. Y Zhang, K Sun, RY Chen, JK Varma and F Zhang interpreted the data. Y Zhang, K Sun, RY Chen, JK Varma and F Zhang suggested additional analyses. Y Zheng and K Sun made the figures. Y Zhang and K Sun drafted the report. All authors reviewed, revised and approved the final report.

Acknowledgement

The authors would like to thank F Scano at the WHO for his careful review of the manuscript.

Financial & competing interests disclosure

This study was supported in part by the China Ministry of Science and Technology Chinese National Basic Research Program (973:2006CB504201). The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Ethical conduct of research

The authors state that they have obtained appropriate institutional review board approval or have followed the principles outlined in the Declaration of Helsinki for all human or animal experimental investigations. In addition, for investigations involving human subjects, informed consent has been obtained from the participants involved.

Additional information

Funding

This study was supported in part by the China Ministry of Science and Technology Chinese National Basic Research Program (973:2006CB504201). The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.No writing assistance was utilized in the production of this manuscript.