Background: Tuberculosis (TB) disease affects survival among HIV co-infected patients on antiretroviral therapy\r\n(ART). Yet, the magnitude of TB disease on mortality is poorly understood.\r\nMethods: Using a prospective cohort of 22,477 adult patients who initiated ART between August 2000 and June\r\n2009 in Uganda, we assessed the effect of active pulmonary TB disease at the initiation of ART on all-cause\r\nmortality using a Cox proportional hazards model. Propensity score (PS) matching was used to control for potential\r\nconfounding. Stratification and covariate adjustment for PS and not PS-based multivariable Cox models were also\r\nperformed.\r\nResults: A total of 1,609 (7.52%) patients had active pulmonary TB at the start of ART. TB patients had higher\r\nproportions of being male, suffering from AIDS-defining illnesses, having World Health Organization (WHO) disease\r\nstage III or IV, and having lower CD4 cell counts at baseline (p < 0.001). The percentages of death during follow-up\r\nwere 10.47% and 6.38% for patients with and without TB, respectively. The hazard ratio (HR) for mortality\r\ncomparing TB to non-TB patients using 1,686 PS-matched pairs was 1.37 (95% confidence interval [CI]: 1.08 ââ?¬â?? 1.75),\r\nless marked than the crude estimate (HR = 1.74, 95% CI: 1.49 ââ?¬â?? 2.04). The other PS-based methods and not PS-based\r\nmultivariable Cox model produced similar results.\r\nConclusions: After controlling for important confounding variables, HIV patients who had TB at the initiation of\r\nART in Uganda had an approximate 37% increased hazard of overall mortality relative to non-TB patients.
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