[procaare] HIV-TB Cases Decline, Survival Increasing: Study

[ProCAARE <procaare@usa.healthnet.org>]

"HIV-TB Cases Decline, Survival Increasing: Study"
Reuters Health (04.05.02)::Megan Rauscher
*******************

HIV-positive patients with tuberculosis are living longer,
probably due to better treatments for HIV and TB, according to a
study conducted in Atlanta and published this month in the
journal Clinical Infectious Diseases (2002;34:1002-1007).

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."

Source: CDC HIV/STD/TB Prevention News Update,  April 10, 2002
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