April 10, 2002
To determine factors associated with the occurrence of HIV and TB and the associated survival rate, Dr. C. Robert Horsburgh, Jr. of Boston University, Dr. Michael K. Leonard of Emory University, and Grady Memorial Hospital, Atlanta and their colleagues analyzed patients with HIV-TB at the hospital from 1991 through 2000.
Overall, 644 patients with HIV-TB were studied. The number of HIV-TB cases per year was highest in 1992 (102 cases) and declined to 39 cases in 2000. Over time, patients were more likely to be enrolled in the HIV outpatient clinic, but, in 1997, only 21 (51%) of 41 patients were enrolled in HIV-infection care programs and only 9 (22%) of 41 received highly active antiretroviral therapy (HAART). The 1-year survival rate for patients with HIV-TB was 58% in 1991, 81% in 1994, and 83% in 1997.
The researchers attribute the decline in HIV-TB cases to tighter hospital infection-control measures instituted at Grady Memorial in 1992. Also, since 1993, all HIV-infected patients attending the hospital's HIV outpatient clinic have undergone tuberculin skin testing and are promptly treated for latent TB.
While the researchers believe that improved therapy for active TB played a role in reducing the number of TB cases among HIV-infected patients and the widespread use of HAART may have rendered HIV-positive patients less susceptible to TB, many patients were not receiving HAART.
The most important message, however, is how patients are helped in receiving health care. "The take-home message is that patients with HIV and TB need to be treated promptly for both diseases," Horsburgh said. However, he noted "gaining and maintaining access to healthcare are major obstacles for these patients."
According to the authors, few patients in the study were on HAART and most did not receive follow-up HIV care at a clinic after being diagnosed with TB. "Increased administration of HAART to these patients is needed and could potentially lead to further improvement in survival rates."