Human Immunodeficiency Virus Infection-Associated Mortality during Pulmonary Tuberculosis Treatment in Six Provinces of China

Objective To investigate the risk factors attributable to tuberculosis-related deaths in areas with human immunodeficiency virus（HIV） infection epidemics. Methods A prospective cohort study of newly registered patients in tuberculosis（TB） dispensaries in six representative Chinese provinces was conducted from September 1, 2009 to August 31, 2011. Risk factors for TB-associated death were identified through logistic regression analysis. Results Of 19,103 newly registered pulmonary TB patients, 925（4.8%） were found to be HIV-positive. Miliary TB and acid-fast bacillus smear-negative TB were more common among these patients. Out of a total of 322（1.7%） deaths that occurred during TB treatment, 85（26%） of the patients were co-infected with HIV. Multivariate analysis revealed that HIV infection was the strongest predictor of death [adjusted odds ratio（aO R） 7.86]. Other significant mortality risk factors included presentation with miliary TB（aO R 4.10; 95% confidence interval： 2.14-7.88）, ≥35 years of age（aO R 3.04）, non-Han ethnicity（aO R 1.67）, and farming as an occupation（aO R 1.59）. For patients with TB/HIV co-infection, miliary TB was the strongest risk factor for death（aO R 5.48）. A low CD4 count（≤ 200 cells/μL）（aO R 3.27） at the time of TB treatment initiation and a lack of antiretroviral therapy（ART） administration（aO R 3.78） were also correlated with an increased risk of death. Conclusion Infection with HIV was independently associated with increased mortality during TB treatment. Offering HIV testing at the time of diagnosis with TB, early TB diagnosis among HIV/acquired immunodeficiency syndrome patients, and the timely provision of ART were identified as the key approaches that could reduce the number of HIV-associated TB deaths.

Research on performance-based seismic design criteria

The seismic design criterion adopted in the existing seismic design codes is reviewed. It is pointed out that the presently used seismic design criterion is not satisfied with the requirements of nowadays social and economic development. A new performance-based seismic design criterion that is composed of three components is presented in this paper. It can not only effectively control the economic losses and casualty, but also ensure the building's function in proper operation during earthquakes. The three components are: classification of seismic design for buildings, determination of seismic design intensity and/or seismic design ground motion for controlling seismic economic losses and casualties, and determination of the importance factors in terms of service periods of buildings. For controlling the seismic human losses, the idea of socially acceptable casualty level is presented and the 'Optimal Economic Decision Model' and 'Optimal Safe Decision Model' are established. Finally, a new method is recommended for calculating the importance factors of structures by adjusting structures service period on the base of more important structure with longer service period than the conventional ones. Therefore, the more important structure with longer service periods will be designed for higher seismic loads, in case the exceedance probability of seismic hazard in different service period is same.