Volume 19, Number 3—March 2013
CME ACTIVITY - Research
Tuberculosis and HIV Co-infection, California, USA, 1993–2008
, Travis C. Porco, Janice Westenhouse, Mark Damesyn, Matt Facer, Julia Hill, Qiang Xia, James P. Watt, Philip C. Hopewell, and Jennifer Flood
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.