Outcome of HIV-associated tuberculosis in the era of highly active antiretroviral therapy

Background. The benefit of highly active antiretroviral therapy (HAART) in the treatment of patients coinfected with tuberculosis (TB) and human immunodeficiency virus (HIV) is unclear because of concerns about treatment-related complications. Methods. We compared outcomes in patients starting TB treatment during the pre-HAART era (before 1996; n = 36) with those in patients starting treatment during the HAART era (during or after 1996; n = 60). Results. During a median of 3.6 years of follow-up, 49 patients died or had an AIDS event. Compared with patients in the pre-HAART group, those in the HAART group had a lower risk of death (cumulative at 4 years, 43% vs. 22%; P = .012) and of death or having an AIDS event (69% vs. 43%; P = .023). Event risk within the first 2 months of TB treatment was exceptionally high in patients with CD4+ cell counts <100 cells/mm3 and declined thereafter. HAART use during follow-up was associated with a marked reduction in event risk (adjusted hazard ratio, 0.38 [95% confidence interval, 0.16-0.91]). Conclusions. HAART substantially reduces new AIDS events and death in coinfected patients. Those with a CD4+ cell count <100 cells/mm3 have a high event risk during the intensive phase of anti-TB treatment. These data should be taken into account when deciding to delay HAART in coinfected patients with CD4+ cell counts <100 cells/mm3.