S58 TB co-infection is associated with poor survival among HIV infected patients in england and wales

Introduction Tuberculosis (TB) rates in the UK are amongst the highest in Western Europe and HIV-TB co-infection (HIV-TB) contributes significantly to the burden of TB in the UK. Globally, HIV-TB is associated with significant morbidity and mortality, in particular where there is delayed diagnosis. Analysis of setting-specific survival can inform local healthcare policy. Here we report the outcome of individuals diagnosed with HIV in the UK, with particular emphasis on TB co-infection.Methodology We examined deaths among a retrospective national cohort of adults (15 years +) diagnosed with HIV infection between 2000–2008 linked to the national TB databases and death records from the Office of National Statistics to mid-2010. Hazard ratios (HR) estimates using uni- and multi-variable Cox regression modelling were calculated to compare all-cause and AIDS-specific mortality by key demographic and clinical markers.Results A total of 1,880 (4.3%) deaths were observed among 44,050 HIV-diagnosed adults during 149,663 person-years of follow-up. 3,188 (7.2%) adults developed TB and HIV-TB cases accounted for 341 (18.1%) of all deaths of whom 270 (79.2%) were late presenters (CD4<200 at HIV diagnosis). One year mortality after HIV diagnosis was 45% overall and greater among HIV-TB cases (54%) and those with low CD4 counts at diagnosis (69% for CD4<50). TB co-infection and a low CD4 count at HIV diagnosis significantly increased the hazard of all-cause mortality. In the fully adjusted model, the highest HR was among adults with extrapulmonary TB and pulmonary TB cases with CD4 count