HIV This Week

Thuy TT, Shah NS, Anh MH, Nghia do T, Thom D, Linh T, Sy DN, Duong BD, Chau LT, Mai PT, Wells CD, Laserson KF, Varma JK. HIV-associated TB in An Giang Province, Vietnam, 2001-2004: epidemiology and TB treatment outcomes. PLoS ONE 2007;62:e507.

Mortality is high in HIV-infected tuberculosis (TB) patients, but few studies from Southeast Asia have documented the benefits of interventions, such as co-trimoxazole (CTX), in reducing mortality during TB treatment. To help guide policy in Vietnam, Thuy and colleagues studied the epidemiology of HIV-associated TB in one province and examined factors associated with outcomes, including the impact of CTX use. The authors retrospectively abstracted data for all HIV-infected persons diagnosed with TB from 2001-2004 in An Giang, a province in southern Vietnam in which TB patients receive HIV counselling and testing. The authors used standard WHO definitions to classify TB treatment outcomes. They conducted multivariate analysis to identify risk factors for the composite outcome of death, default, or treatment failure during TB treatment. From 2001-2004, 637 HIV-infected TB patients were diagnosed in An Giang. Of these, 501 (79%) were male, 321 (50%) were aged 25-34 years, and the most common self-reported HIV risk factor was sex with a commercial sex worker in 221 (35%). TB was classified as smear-positive in 531 (83%). During TB treatment, 167 (26%) patients died, 9 (1%) defaulted, and 6 (1%) failed treatment. Of 454 patients who took co-trimoxazole (CTX), 116 (26%) had an unsuccessful outcome compared with 33 (70%) of 47 patients who did not take CTX (relative risk, 0.4; 95% confidence interval [CI], 0.3-0.5). Adjusting for male sex, rural residence, TB smear status and disease location, and the occurrence of adverse events during TB treatment in multivariate analysis, the benefit of CTX persisted (adjusted odds ratio for unsuccessful outcome 0.1; CI, 0.1-0.3). In An Giang, Vietnam, HIV-associated TB was associated with poor TB treatment outcomes. Outcomes were significantly better in those taking CTX. This finding suggests that Vietnam should consider applying WHO recommendations to prescribe CTX to all HIV-infected TB patients.

Editors’ note: Patients co-infected with TB and HIV are at high risk of death not only because of TB but also due to increased susceptibility to pneumonia and other infections. These data from southern Vietnam reinforce the benefits of co-trimoxazole – it should be offered to all adults with TB at the onset of anti-TB treatment as an effective, simple, and safe way to reduce mortality, especially in settings where HIV co-infection is common.