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Does the onset of tuberculosis in AIDS predict shorter survival? Results of a cohort study in 17 European countries over 13 years

^a Institute of Social and Preventive Medicine, University of Geneva, CMU Case Postale, 1211 Geneva 4, Switzerland, ^b Division of Infectious Diseases, Geneva University Hospital, Geneva, ^c University of Copenhagen, Hvidovre Hospital, Hvidovre, Denmark

AIDS in Europe Study Group Members of the study group are listed in reference 7. Correspondence to: Dr Perneger.

Abstract

Objective: To assess the impact of tuberculosis on mortality in patients with AIDS.
Design: Community based cohort study.
Setting: 52 centres in 17 countries (AIDS in Europe study).
Subjects: 5249 patients who were alive and free of tuberculosis one month after the diagnosis of AIDS, enrolled between 1979 and 1989, and followed up until 1992.
Main outcome measures: Onset of clinically active tuberculosis or death, or both.
Results: During a mean follow up period of 15 months 201 (4%) patients developed tuberculosis and 3889 (74%) died. Patients who developed tuberculosis survived significantly longer (median 22 months) than those who did not (median 16 months). This apparent survival advantage was due to patients who survived longer having more opportunity to develop tuberculosis (or any other disease). In models that took into account the time at which tuberculosis was diagnosed, the onset of tuberculosis was associated with a significant increase in mortality (adjusted relative hazard of death 1.34; 95% confidence interval 1.12 to 1.60).
Conclusions: The onset of tuberculosis in patients with AIDS predicts a substantial increase in mortality. Whether this increased mortality is directly attributable to the tuberculosis remains uncertain. If the association is causal preventive chemotherapy and aggressive treatment of tuberculosis could improve survival in AIDS.

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