Tuberculosis as primary cause of death among AIDS cases in Rio de Janeiro Brazil.

The tuberculosis (TB) epidemic is fueled worldwide by human immunodeficiency virus (HIV) infection, and HIV poses the greatest threat to TB control.1 The World Health Organization (WHO) estimated that there were 8.9 million new cases of TB in 2005. Of these, 741 000 were among HIV-infected adults. TB may have caused 1.7 million deaths in 2004 and 248 000 in TB-HIV co-infected individuals.2 The Joint United Nations Program on HIV/AIDS (acquired immune-deficiency syndrome) estimated that 2.9 million AIDS deaths would occur in 2006, 65 000 of which in Latin America.3 Brazil has an estimated 600 000 HIV-infected individuals aged between 15 and 49 years.4 According to the Brazilian Ministry of Health, 85 000 new TB cases occur annually, causing 6000 deaths.5 AIDS-related mortality decreased in Rio de Janeiro City (RJC) in the 2 years following the introduction (in 1997) of highly-active antiretroviral treatment (HAART), which is widely available free of charge. Since 1999, AIDS-related mortality has been stable.6 More than 26 000 AIDS cases have been reported since the beginning of the epidemic,7 and approximately 8000 TB cases are reported annually.8 Among TB patients seeking care in primary health units in RJC, one study showed that approximately 10% were infected with HIV.9 To determine the role played by TB among Brazil’s HIV-positive population, we investigated the frequency of TB as the primary cause of death among HIV-positive subjects in RJC. We also looked at the use of HAART by co-infected patients, aiming to use that as a proxy of access to care and to assess relationships between HAART and survival.