[Skip to Content]
[Skip to Content Landing]
Article
October 1992

Survival in a Cohort of Human Immunodeficiency Virus—Infected Tuberculosis Patients in New York City: Implications for the Expansion of the AIDS Case Definition

Author Affiliations

From the New York City (NY) Department of Health (Drs Stoneburner, Laroche, Prevots, Singh, Blum, and Reatrice and Mr Terry); and the Tuberculosis Elimination Program, Mount Sinai Medical Center, New York, NY (Dr Adler).

Arch Intern Med. 1992;152(10):2033-2037. doi:10.1001/archinte.1992.00400220061010
Abstract

Background.—  The occurrence of pulmonary tuberculosis in human immunodeficiency virus (HIV)—infected persons is believed to represent a less severe stage of HIV-related disease with a more favorable prognosis than other acquired immunodeficiency syndrome (AIDS)—defining conditions; therefore, it has been excluded from the AIDS definition established by the Centers for Disease Control (Atlanta, Ga) criteria.

Methods.—  To determine the prognosis of patients with HIV-related tuberculosis, we assessed the clinical, immunologic, and HIV infection status of a cohort of male subjects aged 20 to 44 years who were hospitalized with tuberculosis but without AIDS in New York City hospitals from 1985 through 1986, and we determined their mortality through May 1991.

Results.—  The 58 patients who agreed to participate were largely (90%) nonwhite and had a high prevalence of pulmonary tuberculosis (90%) and HIV infection (53%). Patients who were HIV seropositive had significantly lower CD4 cell counts (median, 0.136×109/L; range, 0.013×109 to 2.314×109/L vs median, 0.765 × 109/L; range, 0.284 × 109 to 2.333×109/L), and, during the follow-up period, an 83% mortality rate that was 7.5 times higher than the 11% rate in seronegative subjects. Survival analyses revealed that for all HIV-seropositive subjects the probability of death at 30 months was 72% and the median survival was 21 months (95% confidence interval, 15.5 to 26.5 months), while for HIV-seropositive subjects with CD4 cell counts of 0.2×109/L or less, the probability of death at 30 months was 92% and the median survival was 15.75 months (95% confidence interval, 14.0 to 17.6 months).

Conclusion.—  The prognosis for patients with HIV-related pulmonary tuberculosis is poor, and those with CD4 cell counts of 0.2×109/L or less have survival patterns similar to that of patients with AIDS. We believe that these data support the expansion of the AIDS case definition to include persons with both pulmonary tuberculosis and severe HIV-related immunosuppression.(Arch Intern Med. 1992;152:2033-2037)

References
1.
Pitchenik AE, Cole C, Russell BW, Fischl MA, Spira TJ, Snider DE Jr.  Tuberculosis, atypical mycobacteriosis and the acquired immunodeficiency syndrome among Haitian and non-Haitian patients in south Florida .  Ann Intern Med. 1984;101:641-645.Crossref
2.
Sunderam G, McDonald RJ, Maniatis T, Oleske J, Kapila R, Reichman LB.  Tuberculosis as a manifestation of the acquired immunodeficiency syndrome (AIDS) .  JAMA. 1986;256:357-361.Crossref
3.
Centers for Disease Control.  Revision of the Centers for Disease Control surveillance case definition for acquired immunodeficiency syndrome .  MMWR. 1987;36:1-15S.
4.
Centers for Disease Control.  Classification system for human T-lymphotropic virus type III/lymphadenopathy-associated virus infections .  MMWR. 1986;35:334-339.
5.
Stoneburner RL, Des Jarlais DC, Milberg J, Friedman SR, Sotheran JL.  Evidence for a causal association between HIV infection and increasing tuberculosis in New York City . Presented at the  Third International Conference on AIDS; Washington, DC, June 1-5, 1987 .
6.
Centers for Disease Control.  Tuberculosis and the acquired immunodeficiency syndrome: New York City .  MMWR. 1987;36:785-790, 795.
7.
Bloch AB, Reider HL, Kelly GD, et al.  The epidemiology of tuberculosis in the United States .  Semin Respir Infect. 1989;4:157-170.
8.
Reider HL, Cauthen GM, Comstock GW, et al.  Epidemiology of tuberculosis in the United States .  Epidemiol Rev. 1989;11:79-98.
9.
Barnes PF, Bloch AB, Davidson PT, Snider DE.  Tuberculosis in patients with the human immunodeficiency virus infection .  N Engl J Med. 1991;324:1644-1650.Crossref
10.
New York City Department of Health.  Tuberculosis in New York City 1989 . New York, NY: New York City Dept of Health; 1990.
11.
Theur CP, Hopewell PC, Elias D, et al.  Human immunodeficiency virus infection in tuberculosis patients .  J Infect Dis. 1990;162:8-12.Crossref
12.
Chiasson RE, Hopewell PC.  Survival after active tuberculosis in patients with HIV infection .  Am Rev Respir Dis. 1990;142:259.Crossref
13.
Shafer RW, Chirgwin KD, Glatt AE, et al.  HIV prevalence, immunosuppression, and drug resistance in patients with tuberculosis in an area endemic for AIDS .  AIDS. 1991;5:399-405.Crossref
14.
National Center for Health Statistics.  National Death Index User's Manual . Hyattsville, Md: National Center for Health Statistics; (September) 1990. Dept of Health and Human Services publication No. PHS 90-1148.
15.
SAS Institute Inc Staff. SAS Users Guide: Statistics: Version 5. Rev ed. Cary, NC: SAS Institute; 1985.
16.
Brudney K, Dobkin J.  Resurgent tuberculosis in New York City: homelessness and the decline of tuberculosis control programs .  Am Rev Respir Dis. 1991;144:745-749.Crossref
17.
Centers for Disease Control. National HIV seroprevalence surveys: summary of results, data from surveillance activities through 1989. Washington, DC: Government Printing Office; 1990. Dept of Health and Human Services publication No. HIV/Centers for Disease Control/9-90/ 006.
18.
Colebunders RL, Ryder RW, Nzilambi N, et al.  HIV infection in patients with tuberculosis in Kinshasa, Zaire .  Am Rev Respir Dis. 1989;139:1082-1085.Crossref
19.
Small PM, Schecter GF, Goodman PC, et al.  Treatment of tuberculosis in patients with advanced human immunodeficiency virus infection .  N Engl J Med. 1991;324:289-294.Crossref
20.
Laroche E, Stoneburner R, Araneta M, Adler J.  Survival experience after TB diagnosis in 1452 AIDS cases: implications for the expansion of the AIDS case definition . Poster presentation at the  Sixth International Conference on AIDS, San Francisco, Calif; June 20-24, 1990 . Poster Th.C.694.
21.
Rothenberg R, Woelfel M, Stoneburner R, et al.  Survival with acquired immunodeficiency syndrome: experience with 5833 cases in New York City .  N Engl J Med. 1987;317:1297-1302.Crossref
22.
Lemp GF, Payne SF, Neal D, Temelso T, Rutherford G.  Survival trends for patients with AIDS .  JAMA. 1990;263:402-406.Crossref
23.
Stoneburner R, Des Jarlais DC, Benezra D.  A larger spectrum of severe HIV-1 related disease in intravenous drug users in New York City .  Science. 1988;242:916-919.Crossref
24.
Selwyn PA, Hartel D, Wasserman W, Drucker E.  Impact of the AIDS epidemic on morbidity and mortality among intravenous drug users in a New York City methadone maintenance program .  Am J Public Health. 1989;79:1358-1362.Crossref
25.
Buehler JW, Devine OJ, Berkelman RL, Chevarley, FM.  Impact of the human immunodeficiency virus epidemic on mortality trends in young men, United States .  Am J Public Health. 1990;80:1080-1086.Crossref
26.
Rosenberg PS, Gail MH, Schrager LK, et al.  National AIDS incidence trends and the extent of zidovudine therapy in selected demographic and transmission groups .  J AIDS. 1991;4:392-401.
×