Mortality and survival of tuberculosis coinfected patients living with AIDS in São Paulo, Brazil: a 12-year cohort study

BACKGROUND: TB is still one of the leading causes of death among HIV patients. This study evaluates the effect of TB on the mortality rate, survival time, and predictors of survival in patients with AIDS living in different areas in São Paulo State (SPS). METHODS: Retrospective cohort of adolescents and adults with AIDS, diagnosed between 2003 and 2007 and followed-up until 2014. Data were obtained from the Brazilian Ministry of Health. Mortality rates were estimated by person-years. Survival analysis used the date of diagnosis as the reference for the construction of Kaplan–Meier curves. The Cox model was used for the investigation of survival-associated factors. RESULTS: A total of 35,515 patients were included, of whom 63.0% were male; 64.7% at the age group of 30 to 49 years, 64.4% were white, 12.9% co-infected with TB, and 37.6% had CD4 count above 200 cells/mm(3) at diagnosis of AIDS. The 12-year survival probabilities were 74.1% and 55.7% among patients without and with TB co-infection, respectively. After adjustment for sex, age and year of diagnosis, the following exposures were independently associated with lower survival: residing in municipalities of the Interior (Hazard ratio (HR) = 1.43) and Coastal Area (HR = 1.9); illiteracy (HR = 2.61); being co-infected with TB (HR = 1.70); CD4 count below 200 cells/mm(3) at AIDS diagnosis (HR = 2.31); viral load above 500 copies/ml at AIDS diagnosis (HR = 1.99); HAART1 regimen (one non-nucleoside reverse transcriptase inhibitor or boosted old protease inhibitors) (HR = 1.94). CONCLUSION: The impact of TB on survival of AIDS was heterogeneous, and affected by age, years of formal education, early AIDS diagnosis, and proper ARV treatment. These factors may not fully explain the different survival outcomes in each of the four regions within the same state. These results may subsidize focused interventions and public health policies conveying specific needs in each of the areas.