PREDICTORS OF AIDS IN A COHORT OF HIV-INFECTED PATIENTS WITH PULMONARY OR PLEURAL TUBERCULOSIS

We estimated the cumulative probability of AIDS in a cohort of 191 HIV-positive patients with pulmonary or pleural tuberculosis, as well as the role of age, sex, district of residence, risk group, alcoholism, homelessness, prison history, site of tuberculosis, radiology, tuberculin skin test and lymphocyte subsets as predictive factors for AIDS development. The 1 year cumulative probability of AIDS for all patients was 27.7% (95% CI:21.7-35.0) and 38.6% (95% CI:31.5-46.7) at 2 years. In the univariate analysis (Kaplan Meier method) the following categories were associated with a higher probability of AIDS: older age group (P=0.014), exclusively homosexual risk group (P=0.005), radiology without cavitary pattern (P<0.001), negative tuberculin skin test (P<0.001), low CD4 percentage (P=0.068) and low CD4-CD8 ratio (P=0.002). At the multivariate level (Cox method), older age group (risk ratio=24.45,95% CI=2.1-286.1), radiology without cavitary pattern (risk ratio=15.68, 95% CI=1.1-211.0), and low CD4-CD8 ratio (risk ratio=50.77, 95 % CI=3.9-645.0) were associated with a higher probability of AIDS. A positive tuberculin skin test had a protective effect (risk ratio=0.009, 95% CI=0.01-0.61). Findings from this cohort study suggest that pulmonary and/or pleural tuberculosis in HIV infected patients should be seriously considered as criteria for AIDS when a negative tuberculin skin test and/or low T4/T8 ratio is present, especially in older people without cavitary radiologic pattern.