Factors Impacting Early Mortality in TuberculosisHIV Patients Differences between Subjects Na？ve to and Previously Started on HAART 英文参考文献.docVIP

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Factors Impacting Early Mortality in TuberculosisHIV Patients Differences between Subjects Na？ve to and Previously Started on HAART 英文参考文献.doc

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Factors Impacting Early Mortality in TuberculosisHIV Patients Differences between Subjects Na？ve to and Previously Started on HAART 英文参考文献

FactorsImpactingEarlyMortalityinTuberculosis/HIV Patients:DifferencesbetweenSubjectsNa?¨vetoand PreviouslyStartedonHAART CarolinaAranaStanisSchmaltz1*,GuilhermeSantoro-Lopes2,MariaCristinaLourenc?o3 ,Mariza Gonc?alvesMorgado4,LucianedeSouzaVelasque1,5,Vale′riaCavalcantiRolla1 1ClinicalResearchLaboratoryonMycobacteriosisofInstitutodePesquisaCl?′nicaEvandroChagas–Fundac?a?o OswaldoCruz(Fiocruz),RiodeJaneiro,Brazil,2Infectious Diseases Clinic, Hospital Universita′rio Clementino Fraga Filho and Department of Preventive Medicine, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil, 3BacteriologyLaboratory,InstitutodePesquisaCl?′nicaEvandroChagas,Fiocruz,RiodeJaneiro,Brazil,4ImmunologyLaboratory,InstitutodePesquisaClinicaEvandro Chagas,Fiocruz,RiodeJaneiro,Brazil,5DepartmentofMathmaticsandStatistics,UniversidadeFederaldoEstadodoRiodeJaneiro,RiodeJaneiro,Brazil Abstract Background:Mortalityamongpatientswithtuberculosis(TB)/HIVishighestduringthefirstfewmonthsofantituberculous therapy.TheobjectiveofthisstudywastoassessthefactorsassociatedwithearlymortalityamongTB/HIVpatientsand whetherthesefactorsaresimilarforHAARTna?¨veandthosewithpriorHAARTinitiation. Methods: Prospective cohort study including HIV patients with tuberculosis confirmed by culture, cared for at a referral center in Rio de Janeiro, Brazil. Multivariable Coxanalysis was used to assess predictors of mortality within 3 months of antituberculoustherapy. Results:Among227patientsincluded,90(40%)startedHAARTbeforeTBdiagnosis.ThemediantimetoTBdiagnosisafter ARV initiation was 5.9 months (interquartile range [IQR] 3.0–8.9 months). Fourteen patients (6%) died within the first 3 months.MortalitywasnotdifferentbetweenpatientspreviouslystartedonHAARTandthosewhowerena?¨vetoit.Inthe overalladjustedanalysis,HAARTuseduringTBtreatment(hazardratio[HR]=0.21,95%confidentialinterval[CI]=0.06–0.72) and CD4 lymphocyte count .100cells/mm3 (HR=0.21, 95% CI=0.04–0.99) were associated with lower mortality, while subje