Progression of human immunodeficiency virus infection in patients with tuberculosis disease

To assess the role of Mycobacterium tuberculosis disease in human immunodeficiency virus (HIV) infection, the authors compared survival of tuberculosis patients and controls matched on year of HIV diagnosis and CD4+ lymphocyte count. Patients were selected in the Aquitaine Cohort, which follows, since 1985, all patients infected with HIV, aged more than 13 years, in five hospitals. Time of inclusion of controls was the date of diagnosis of tuberculosis for the corresponding tuberculosis patient. Patients who had received primary prophylaxis against mycobacteria other than tuberculosis were excluded. As of June 30, 1994, 104 tuberculosis patients and 620 controls were selected; they were similar, except for history of intravenous drug use (tuberculosis patients, 51%, vs. controls, 31%) and AIDS-defining opportunistic infection (40 vs. 29%). Survival was shorter in tuberculosis patients than in controls (risk ratio 1.5, 95% confidence interval 1.2-2.1) even after controlling for differences at entry. The risk of AIDS-defining opportunistic infection or a decrease to fewer than 50 CD4+ cells/mm(3) was slightly but not statistically greater in tuberculosis patients than in controls. Tuberculosis disease affected survival but not occurrence of subsequent opportunistic infections or rate of CD4+ count decline. Tuberculosis may be a marker of advanced HIV and may accelerate its course of infection.