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Volume 19, Number 3—March 2013

CME ACTIVITY

Tuberculosis and HIV Co-infection, California, USA, 1993–2008

John Z. MetcalfeComments to Author , Travis C. Porco, Janice Westenhouse, Mark Damesyn, Matt Facer, Julia Hill, Qiang Xia, James P. Watt, Philip C. Hopewell, and Jennifer Flood
Author affiliations: Author affiliations: University of California, San Francisco, California, USA (J.Z. Metcalfe, T.C. Porco, P.C. Hopewell); California Department of Public Health, Richmond, California, USA (J. Westenhouse, J. Hill, J.P. Watt, J. Flood); California Department of Public Health, Sacramento, California, USA (M. Damesyn, M. Facer); RTI International, Research Triangle Park, North Carolina, USA (Q. Xia)

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Table 2

Clinical characteristics of TB patients with and without known HIV co-infection, California, USA, 1993–2008*

Characteristic TB without known HIV
TB with HIV
p value†
1993–1995, n = 13,297 1996–2000, n = 17,768 2001–2008, n = 22,558 1993–1995, n = 1,343 1996–2000, n = 1,307 2001–2008, n = 1,254
Extrapulmonary TB‡ 2,343 (18) 3,351 (19) 4,621 (21) 222 (17) 230 (18) 213 (17) 0.11

Referent
1.07 (1.02–1.12)
1.16 (1.11–1.22)

Referent
1.06 (0.9–1.26)
1.03 (0.87–1.22)

Pulmonary TB
AFB smear-positive 4,200 (45) 6,002 (47) 8,338 (50) 577 (55) 531 (52) 546 (53) <0.01
Referent 1.04 (1.01–1.07) 1.10 (1.07–1.13) Referent 0.94 (0.87–1.02) 0.97 (0.89–1.05)
AFB smear-negative, culture positive 3,180 (34) 4,301 (34) 5,093 (31) 347 (33) 339 (33) 325 (32) 0.37
Referent 0.98 (0.95–1.02) 0.90 (0.87–0.93) Referent 1.00 (0.89–1.13) 0.96 (0.85–1.08)
Culture-negative§ 2,216 (21) 2,805 (20) 3,477(20) 110 (10) 155 (15) 167 (16) 0.001
Referent 0.94 (0.90–0.99) 0.92 (0.88–0.97) Referent 1.16 (0.94–1.44) 1.29 (1.05–1.59)
Cavitary disease 2,255 (21) 2, 981 (21) 4,128 (23) 117 (11) 79 (7) 97 (9) 0.21

Referent
1.00 (0.95–1.05)
1.12 (1.07–1.17)

Referent
0.70 (0.53–0.91)
0.88 (0.68–1.14)

Median time to culture conversion, mo (IQR) 1.9 (1.0–3.4) 1.8 (0.9–2.9) 1.5 (0.8–2.4) 2.0 (1.1–4.2) 1.5 (0.8–2.8) 1.2 (0.7–2.3) 0.19
Median CD4 count, cells/mm3 (IQR)¶ NA NA NA 114 (60–179) 103 (52–162) 100 (55–150)** NA
Viral load¶
NA
NA
NA

50,282 (21,203–97,644)
68,501 (28,054–119,655) **
83,402 (28,994–177,698) **
NA
Drug resistance#
INH resistant** 832 (8) 1,268 (8) 1,541 (8) 55 (5) 65 (5) 72 (6) 0.10
Referent 1.07 (0.98–1.16) 1.02 (0.94–1.11) Referent 1.15 (0.81–1.63) 1.34 (0.95–1.89)
PZA nonoresistance 138 (1) 322 (2) 636 (3) 24 (2) 68 (6) 93 (8) <0.05
Referent 1.63 (1.34–2.00) 2.53 (2.11–3.04) Referent 2.74 (1.73–4.33) 3.94 (2.53–6.13)
MDR 148 (1) 186 (1) 257 (1) 9 (1) 7 (1) 10 (1) 0.90
Referent 0.88 (0.71–1.09) 0.96 (0.78–1.17) Referent 0.76 (0.28–2.03) 1.14 (0.46–2.79)
Deceased at diagnosis 319 (2.4) 406 (2.3) 359 (1.6) 50 (3.7) 40 (3.1) 26 (2.1) 0.50

Referent
0.95 (0.82–1.10)
0.66 (0.57–0.77)

Referent
0.82 (0.55–1.24)
0.56 (0.35–0.89)

Final treatment outcome††
Completed treatment 10,598 (83) 14,807 (87) 18,048 (87) 713 (56) 937 (75) 901 (78)
1.39 (1.31–1.47) <0.001
Referent 1.04 (1.03–1.05) 1.05 (1.04–1.06) Referent 1.34 (1.27–1.42)
Defaulted 519 (4) 334 (2) 480 (2) 60 (5) 37 (3) 38 (3) 0.61
Referent 0.48 (0.42–0.55) 0.57 (0.50–0.64) Referent 0.63 (0.42–0.94) 0.70 (0.47–1.04)
Transferred 780 (6) 775 (5) 842 (4) 121 (10) 79 (6) 59 (5) 0.19
Referent 0.74 (0.67–0.82) 0.66 (0.60–0.73) Referent 0.67 (0.51–0.88) 0.54 (0.40–0.72)
Died 864 (7) 1,161 (7) 1,394 (7) 375 (30) 190 (15) 158 (14) <0.001
Referent 1.00 (0.92–1.09) 0.99 (0.91–1.08) Referent 0.52 (0.44–0.61) 0.46 (0.39–0.55)

*TB diagnoses were grouped into 3 periods: before the availability of highly active antiretroviral therapy (HAART) (1993–1995), early HAART (1996–2000), and late HAART (2001–2008). All values are no. (%)/prevalence ratio (95% CI). The denominator for each characteristic excludes missing or unknown values. TB, tuberculosis; AFB, acid-fast bacilli; IQR, interquartile range; NA, not applicable; INH, isoniazid; PZA, pyrazinamide; MDR, multidrug-resistant.
†p value for difference (TB vs. TB–HIV). Rates of change in prevalence of binary covariates among patients with TB versus patients with TB–HIV were compared by using logistic regression with robust SEs; similarly, rates of change in continuous covariates among patients with TB versus patients with TB–HIV were compared by using linear regression.
‡Without evidence of pulmonary TB.
§Comprising pulmonary and extrapulmonary TB.
¶CD4 count and viral load were imputed (online Technical Appendix, wwwnc.cdc.gov/EID/articles/12-1521-Techapp1.pdf).
#Denominator includes only culture-positive cases.
**Excluding multidrug resistance (defined as laboratory-confirmed resistance to INH and rifampin) and extensive drug resistance (defined as laboratory-confirmed resistance to all of the following, at minimum: INH, rifampin, any fluoroquinolone, and any second-line injectable agent)
††Limited to TB patients who were alive at diagnosis; treatment outcomes for 2007 were incomplete and were excluded.

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