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Tuberculosis in HIV‐infected persons in the context of wide availability of highly active antiretroviral therapy

E. Girardi, G. Antonucci, P. Vanacore, F. Palmieri, A. Matteelli, E. Iemoli, S. Carradori, B. Salassa, M. Bruna Pasticci, M.C. Raviglione, G. Ippolito, the GISTA-SIMIT Study Group
European Respiratory Journal 2004 24: 11-17; DOI: 10.1183/09031936.04.00109303
E. Girardi
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G. Antonucci
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P. Vanacore
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F. Palmieri
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A. Matteelli
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E. Iemoli
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S. Carradori
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B. Salassa
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M. Bruna Pasticci
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M.C. Raviglione
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G. Ippolito
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  • Fig. 1.—
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    Fig. 1.—

    Distribution of 271 HIV‐infected patients by previous knowledge of HIV serostatus and antiretroviral therapy at the time of diagnosis of tuberculosis (TB). Embedded Image: HIV diagnosed concurrently with TB (29.9%); □: HIV diagnosed before TB/not on highly active antiretroviral therapy (HAART; 39.9%); └: on HAART (30.2%).

  • Fig. 2.—
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    Fig. 2.—

    CD4 lymphocytes count in 271 HIV‐infected patients at the time of diagnosis of tuberculosis (TB) by previous knowledge of HIV serostatus and antiretroviral therapy status. The median value (––), interquartile range and outliers are shown. Mann-Whitney U‐test was used for statistical comparisons. HIV+ at TB: HIV infection diagnosed concurrently with TB (n=81); no HAART at TB: not on antiretroviral therapy at TB diagnosis (n=108); HAART at TB: on antiretroviral therapy at TB diagnosis (n=82). **: p<0.01; #: p>0.05.

Tables

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  • Table 1—

    Characteristics of 271 HIV‐infected patients diagnosed with tuberculosis

    Patient characteristics
    Age yrs median (IQR)37 (32–41)
    Sex
     Male221 (81.5)
     Female50 (18.5)
    Place of birth
     Italy177 (65.3)
     Other94 (34.7)
    HIV transmission category
     IDUs130 (48.0)
     Heterosexual contacts76 (28.0)
     MSM39 (14.4)
     Other/undefined26 (9.6)
    Localisation of TB
     Pulmonary150 (55.8)
     Pulmonary+extrapulmonary69 (25.4)
     Extrapulmonary52 (19.1)
    CD4 lymphocyte count cells·mm−3 median (IQR)120 (44–284)
    Previous episode of tuberculosis45 (16.6)
    Previous treatment for latent TB infection3 (1.5)
    • Data are presented as n (%) unless otherwise indicated

    • TB: tuberculosis

    • IQR: interquartile range

    • IDUs: injecting drug users

    • MSM: males who have sex with males

  • Table 2—

    Proportion of patients with diagnosis of HIV infection concurrent with diagnosis of tuberculosis (TB) by demographic and epidemiological characteristics

    Patient characteristicsNo. with concurrent HIV‐TB diagnosis/total (%)Adjusted odds ratio# (95% CI)p‐value
    Patients n81/271
    Sex
     Male65/221 (29.4)3.46 (1.34–8.91)0.01
     Female16/50 (32.0)1.00 (ref.)
    Age yrs
     20–3024/43 (55.8)1.03 (0.37–2.88)ns
     31–4032/137 (27.5)0.51 (0.24–1.09)ns
     >4025/91 (27.5)1.00 (ref.)
    Country of birth
     Italy28/177 (15.3)1.00 (ref.)
     Other54/94 (57.4)4.71 (2.19–10.11)<0.001
    HIV transmission category
     IDUs11/130 (8.5)1.00 (ref.)
     Heterosexual contacts34/76 (44.7)6.67 (2.88–15.45)<0.001
     MSM18/39 (46.2)3.72 (1.39–10.01)0.009
     Other/unknown18/26 (69.2)21.68 (6.54–71.89)<0.001
    • IDUs: injecting drug users

    • MSM: males who have sex with males

    • #: estimated in a logistic regression model including the variables listed in the table

  • Table 3—

    Localisation of tuberculosis (TB) and chest radiograph pattern in patients with pulmonary involvement by antiretroviral therapy at the time of diagnosis of TB

    Antiretroviral therapy at the time of diagnosis of TB
    YesNo
    Patients n82189
    Localisation of TB
     Pulmonary50 (61.0)100 (52.9)
     Pulmonary+extrapulmonary15 (18.3)54 (28.6)
     Extrapulmonary17 (20.7)35 (18.5)
    Chest radiograph pattern#
     Upper-lobe infiltrate/cavitation16 (23.2)45 (26.6)
     Lower-lobe infiltrate9 (13.0)24 (14.2)
     Pleural effusion8 (11.6)18 (10.7)
     Miliary/interstitial16 (23.2)36 (21.3)
     Other20 (29.0)46 (27.2)
    • Data are presented as n (%)

    • #: among 216 patients with pulmonary involvement and available results of chest radiograph

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Tuberculosis in HIV‐infected persons in the context of wide availability of highly active antiretroviral therapy
E. Girardi, G. Antonucci, P. Vanacore, F. Palmieri, A. Matteelli, E. Iemoli, S. Carradori, B. Salassa, M. Bruna Pasticci, M.C. Raviglione, G. Ippolito, the GISTA-SIMIT Study Group
European Respiratory Journal Jul 2004, 24 (1) 11-17; DOI: 10.1183/09031936.04.00109303

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Tuberculosis in HIV‐infected persons in the context of wide availability of highly active antiretroviral therapy
E. Girardi, G. Antonucci, P. Vanacore, F. Palmieri, A. Matteelli, E. Iemoli, S. Carradori, B. Salassa, M. Bruna Pasticci, M.C. Raviglione, G. Ippolito, the GISTA-SIMIT Study Group
European Respiratory Journal Jul 2004, 24 (1) 11-17; DOI: 10.1183/09031936.04.00109303
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