Effect of tuberculosis on the survival of women infected with human immunodeficiency virus

H. López-Gatell, S. R. Cole, N. A. Hessol, A. L. French, R. M. Greenblatt, S. Landesman, S. Preston-Martin, K. Anastos

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Abstract

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.

Original languageEnglish (US)
Pages (from-to)1134-1142
Number of pages9
JournalAmerican Journal of Epidemiology
Volume165
Issue number10
DOIs
StatePublished - May 1 2007

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Keywords

  • Acquired immunodeficiency syndrome
  • Causality
  • Disease progression
  • HIV infections
  • Models, statistical
  • Survival analysis
  • Tuberculosis
  • Women

ASJC Scopus subject areas

  • Epidemiology

Cite this

López-Gatell, H., Cole, S. R., Hessol, N. A., French, A. L., Greenblatt, R. M., Landesman, S., Preston-Martin, S., & Anastos, K. (2007). Effect of tuberculosis on the survival of women infected with human immunodeficiency virus. American Journal of Epidemiology, 165(10), 1134-1142. https://doi.org/10.1093/aje/kwk116