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Volume 15, Number 2—February 2009


Causes of Death in HIV-infected Persons Who Have Tuberculosis, Thailand

Kevin P. CainComments to Author , Thanomsak Anekthananon, Channawong Burapat, Somsak Akksilp, Wiroj Mankhatitham, Chawin Srinak, Sriprapa Nateniyom, Wanchai Sattayawuthipong, Theerawit Tasaneeyapan, and Jay K. Varma
Author affiliations: Centers for Disease Control and Prevention, Atlanta, Georgia, USA (K.P. Cain, J.K. Varma); Siriraj Hospital, Mahidol University, Bangkok, Thailand (T. Anekthananon); Thailand Ministry of Public Health, US Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thaliand (C. Burapat, T. Tasaneeyapan, J.K. Varma); Thailand Ministry of Public Health, Nonthaburi (S. Nateniyom); Office of Disease Prevention and Control 7, Ubon Ratchathani, Thailand (S. Akksilp); Bamrasnaradura Institute, Nonthaburi, Thailand (W. Mankhatitham); Bangkok Metropolitan Administration, Bangkok (C. Srinak); Phuket Provincial Public Health Office, Phuket, Thailand (W. Sattayawuthipong)

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Table 3

Adjusted hazard ratios for associations between patient characteristics and causes of death among enrolled patients, Thailand, 2005–2007*

Patient characteristic Death caused by TB,
n = 723† Death caused by 
non-TB HIV-associated cause, n = 745† Death caused by TB 
or HIV equally likely, 
n = 726† Death caused by 
non-TB/HIV condition, 
n = 719†
Used ART‡ 0.2 (0.1–0.5)§ 0.4 (0.2–0.7)§ 0.04 (0.01–0.3)§ 0.9 (0.3–2.6)
Used CPT‡ 0.5 (0.1–1.5) 1.0 (0.3–3.2) 1.0 (0.3–3.5) 1.1 (0.2–5.5)
Used fluconazole‡ 0.5 (0.2–1.2) 0.8 (0.4–1.6) 0.4 (0.2–0.98)§ 1.2 (0.4–3.8)
CD4 0.993 (0.987–0.999)§ 0.987 (0.980–0.994)§ 0.988 (0.981–0.996)§ 1.0 (0.996–1.004)
Ineffective TB regimen¶ 5.0 (2.0–12.6)§ 2.6 (1.4–5.1)§ 0.3 (0.04–2.3) 0.9 (0.2–3.7)
Hepatitis C antibody positive Not included Not included Not included 3.2 (1.2–8.3)§
Hospitalized at enrollment 11.9 (4.4–32.1)§ Not included Not included Not included
Abnormal liver enzyme levels# Not included Not included Not included 5.3 (2.2–12.9)§

*TB, tuberculosis; ART, antiretroviral therapy; CPT, cotrimoxazole preventive therapy; CD4, CD4+ T-cell lymphocyte count; Not included, not retained in final model. Patient counts exclude 27 persons who died within 14 days of TB treatment initiation and 13 patients with missing CD4.
†Each model includes all patients who survived plus those who died of the specific cause noted (in each category, patients who died of any of the other 3 causes were excluded). Values in parentheses are 95% confidence intervals.
‡Must have been taken for >14 days to qualify as taking medication.
¶Ineffective regimens were those without supportive clinical trials data, without international guidelines, or not likely to work because of the drug-resistance pattern of the patient’s isolate.
#Aspartate transaminase >120 units/L and/or alanine aminotransferase >165 units/L and/or bilirubin >2 mg/dL.

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