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Implications for the Expansion of the AIDS Case Definition

Rand Stoneburner, MD; Eddy Laroche, MD; Rebecca Prevots, PhD; Tejinder Singh, PhD; Steve Blum, PhD; Paul Terry, MPH; Sara Reatrice, PhD; Jack Adler, MD

Arch Intern Med. 1992;152(10):2033-2037.

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, 0.136x10⁹/L; range, 0.013x10⁹ to 2.314x10⁹/L vs median, 0.765 x 10⁹/L; range, 0.284 x 10⁹ to 2.333x10⁹/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 0.2x10⁹/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 0.2x10⁹/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)

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).

Footnotes
Accepted for publication February 21, 1992.

Reprint requests to Disease Intervention Research, Box 6, 125 Worth St, New York, NY 10013 (c/o Dr Chiasson).

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