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Bateman M, Wolf A, Chimukangara B, Brust JCM, Lessells R, Amico R, Boodhram R, Singh N, Orrell C, Friedland G, Naidoo K, Padayatchi N, O'Donnell MR. Adherence measured using electronic dose monitoring is associated with emergent antiretroviral resistance and poor outcomes in patients co-infected with HIV/AIDS and multidrug-resistant tuberculosis. Clin Infect Dis 2022; 75:1489-1496. [PMID: 35352097 PMCID: PMC9617578 DOI: 10.1093/cid/ciac232] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Medication adherence is known to challenge treatment of HIV/AIDS and multidrug-resistant tuberculosis (MDR-TB). We hypothesized that electronic dose adherence monitoring (EDM) would identify an ART adherence threshold for emergent ART resistance and predict treatment outcomes in patients with MDR-TB and HIV on ART and bedaquiline-containing TB regimens. METHODS A prospective cohort of adults with MDR-TB and HIV, on ART and initiating MDR-TB treatment with bedaquiline, were enrolled at a public TB referral hospital in KwaZulu-Natal, South Africa (PRAXIS Study, Clinicaltrials.gov NCT03162107). Participants received separate EDM devices measuring adherence to bedaquiline and ART (nevirapine or lopinavir/ritonavir). Adherence was calculated cumulatively over six months. Participants were followed through completion of MDR-TB treatment. HIV genome sequencing was performed at baseline, 2 and 6 months on samples with HIV RNA ≥1000 copies/mL. FINDINGS From November 2016 through February 2018, 198 MDR-TB and HIV co-infected participants were enrolled and followed (median 17.2 months, IQR 12.2 - 19.6). Eleven percent had baseline ART resistance mutations, and 7.5% developed emergent ART resistance at 6 months. ART adherence was independently associated with both emergent ART resistance and mortality. Modeling identified a significant (p<0.001), but linear association between ART adherence and emergent resistance, suggesting a strong association without a specific threshold. INTERPRETATION Our findings highlight the need for ART resistance testing, especially in MDR-TB HIV co-infected patients, which is currently not standard of care in resource-limited settings. Despite short follow-up duration, reduced ART adherence was significantly associated with emergent resistance and increased mortality.
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Affiliation(s)
- Mark Bateman
- Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Allison Wolf
- Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Benjamin Chimukangara
- Critical Care Medicine Department, NIH Clinical Center, Bethesda, Maryland, USA.,CAPRISA MRC- HIV-TB Pathogenesis and Treatment Research Unit, Durban, South Africa
| | - James C M Brust
- Department of Medicine, Albert Einstein College of Medicine, New York, NY, USA
| | - Richard Lessells
- KwaZulu-Natal Research Innovation and Sequencing Platform (KRISP), School of Laboratory Medicine & Medical Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Rivet Amico
- Department of Health Behavior & Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Resha Boodhram
- CAPRISA MRC- HIV-TB Pathogenesis and Treatment Research Unit, Durban, South Africa
| | - Nalini Singh
- King Dinuzulu Hospital Complex, Durban, South Africa
| | | | | | - Kogieleum Naidoo
- CAPRISA MRC- HIV-TB Pathogenesis and Treatment Research Unit, Durban, South Africa
| | - Nesri Padayatchi
- CAPRISA MRC- HIV-TB Pathogenesis and Treatment Research Unit, Durban, South Africa
| | - Max R O'Donnell
- Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University Irving Medical Center, New York, New York, USA.,Department of Epidemiology, Mailman School of Public Health, Columbia University Irving Medical Center, New York, New York, USA.,CAPRISA MRC- HIV-TB Pathogenesis and Treatment Research Unit, Durban, South Africa
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Naidoo K, Rampersad S, Karim SA. Improving survival with tuberculosis & HIV treatment integration: A mini-review. Indian J Med Res 2020; 150:131-138. [PMID: 31670268 PMCID: PMC6829777 DOI: 10.4103/ijmr.ijmr_660_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Tuberculosis (TB) is a leading cause of morbidity and mortality among HIV-infected patients while HIV remains a key risk factor for the development of active TB infection. Treatment integration is a key in reducing mortality in patients with HIV-TB co-infection. However, this opportunity to improve outcomes of both infections is often missed or poorly implemented. Challenges in TB-HIV treatment integration range from complexities involving clinical management of co-infected patients to obstacles in health service-organization and prioritization. This is evident in high prevalence settings such as in sub-Saharan Africa where TB-HIV co-infection rates reach up to 80 per cent. This review discusses published literature on clinical trials and cohort studies of strategies for TB-HIV treatment integration aimed at reducing co-infection mortality. Studies published since 2009, when several treatment guidelines recommended treatment integration, were included. A total of 43 articles were identified, of which a total of 23 observational studies and nine clinical trials were informative on TB-HIV treatment integration. The data show that the survival benefit of AIDS therapy in patients infected with TB can be maximized among patients with advanced immunosuppression by starting antiretroviral therapy (ART) soon after TB treatment initiation, i.e. in patients with CD4+ cell counts <50 cells/μl. However, patients with greater CD4+ cell counts should defer initiation of ART to no less than eight weeks after initiation of TB treatment to reduce the occurrence and extent of immune reconstitution disease and subsequent hospitalization. Addressing operational challenges in integrating TB-HIV care can significantly improve patient outcomes, generate substantial public health impact by decreasing morbidity and death in settings with a high burden of HIV and TB.
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Affiliation(s)
- Kogieleum Naidoo
- Centre for the AIDS Programme of Research in South Africa (CAPRISA); MRC-CAPRISA HIV-TB Pathogenesis and Treatment Research Unit, Doris Duke Medical Research Institute, University of KwaZulu-Natal, Durban, South Africa
| | - Sanisha Rampersad
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa
| | - Salim Abdool Karim
- Centre for the AIDS Programme of Research in South Africa (CAPRISA); MRC-CAPRISA HIV-TB Pathogenesis and Treatment Research Unit, Doris Duke Medical Research Institute, University of KwaZulu-Natal, Durban, South Africa; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, USA
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Rodrigo T, Casals M, Caminero JA, García-García JM, Jiménez-Fuentes MA, Medina JF, Millet JP, Ruiz-Manzano J, Caylá J. Factors Associated with Fatality during the Intensive Phase of Anti-Tuberculosis Treatment. PLoS One 2016; 11:e0159925. [PMID: 27487189 PMCID: PMC4972388 DOI: 10.1371/journal.pone.0159925] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Accepted: 07/11/2016] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To determine the case-fatality rate (CFR) at the end of the intensive phase of tuberculosis (TB) treatment, and factors associated with fatality. METHODS TB patients diagnosed between 2006 and 2013 were followed-up during treatment. We computed the CFR at the end of the intensive phase of TB treatment, and the incidence of death per 100 person-days (pd) of follow-up. We performed survival analysis using the Kaplan-Meier method and Cox regression, and calculate hazard ratios (HR) and 95% confidence intervals (CI). RESULTS A total of 5,182 patients were included, of whom 180 (3.5%) died; 87 of these deaths (48.3%) occurred during the intensive phase of treatment, with a CFR of 1.7%. The incidence of death was 0.028/100 pd. The following factors were associated with death during the intensive phase: being >50 years (HR = 36.9;CI:4.8-283.4); being retired (HR = 2.4;CI:1.1-5.1); having visited the emergency department (HR = 3.1;CI:1.2-7.7); HIV infection (HR = 3.4;CI:1.6-7.2); initial standard treatment with 3 drugs (HR = 2.0;CI:1.2-3.3) or non-standard treatments (HR = 2.68;CI:1.36-5.25); comprehension difficulties (HR = 2.8;CI:1.3-6.1); and smear-positive sputum (HR = 2.3-CI:1.0-4.8). CONCLUSION There is a non-negligible CFR during the intensive phase of TB, whose reduction should be prioritised. The CFR could be a useful indicator for evaluating TB programs.
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Affiliation(s)
- T. Rodrigo
- Programa Integrado de Investigación en Tuberculosis (PII TB), Fundación Respira de la Sociedad Española de Neumología y Cirugía Torácica (SEPAR), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Ministerio de Economía y Competitividad, Madrid, Spain
- Unidad de Investigación de Tuberculosis, Servicio de Epidemiologia, Agencia de Salud Pública de Barcelona, Barcelona, Spain
| | - M. Casals
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Ministerio de Economía y Competitividad, Madrid, Spain
- Unidad de Investigación de Tuberculosis, Servicio de Epidemiologia, Agencia de Salud Pública de Barcelona, Barcelona, Spain
| | - J. A. Caminero
- Programa Integrado de Investigación en Tuberculosis (PII TB), Fundación Respira de la Sociedad Española de Neumología y Cirugía Torácica (SEPAR), Barcelona, Spain
- Servicio de Neumología. Hospital General Universitario de Gran Canaria Dr, Negrín, Canary Islands, Spain
- International Union Against Tuberculosis and Lung Disease, París, France
| | - J. M. García-García
- Programa Integrado de Investigación en Tuberculosis (PII TB), Fundación Respira de la Sociedad Española de Neumología y Cirugía Torácica (SEPAR), Barcelona, Spain
- Servicio de Neumología, Hospital San Agustín de Avilés, Asturias, Spain
| | - M. A. Jiménez-Fuentes
- Programa Integrado de Investigación en Tuberculosis (PII TB), Fundación Respira de la Sociedad Española de Neumología y Cirugía Torácica (SEPAR), Barcelona, Spain
- Unidad de Tuberculosis, Hospital Universitario Valle de Hebrón, Barcelona, Spain
| | - J. F. Medina
- Programa Integrado de Investigación en Tuberculosis (PII TB), Fundación Respira de la Sociedad Española de Neumología y Cirugía Torácica (SEPAR), Barcelona, Spain
- Servicio de Neumología, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - J. P. Millet
- Programa Integrado de Investigación en Tuberculosis (PII TB), Fundación Respira de la Sociedad Española de Neumología y Cirugía Torácica (SEPAR), Barcelona, Spain
- Unidad de Investigación de Tuberculosis, Servicio de Epidemiologia, Agencia de Salud Pública de Barcelona, Barcelona, Spain
| | - J. Ruiz-Manzano
- Programa Integrado de Investigación en Tuberculosis (PII TB), Fundación Respira de la Sociedad Española de Neumología y Cirugía Torácica (SEPAR), Barcelona, Spain
- Servicio de Neumología, Hospital Universitario Germans Trías y Pujol de Badalona, Badalona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Ministerio de Economía y Competitividad, Madrid, Spain
| | - J. Caylá
- Programa Integrado de Investigación en Tuberculosis (PII TB), Fundación Respira de la Sociedad Española de Neumología y Cirugía Torácica (SEPAR), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Ministerio de Economía y Competitividad, Madrid, Spain
- Unidad de Investigación de Tuberculosis, Servicio de Epidemiologia, Agencia de Salud Pública de Barcelona, Barcelona, Spain
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The impact of HAART initiation timing on HIV-TB co-infected patients, a retrospective cohort study. BMC Infect Dis 2014; 14:304. [PMID: 24897928 PMCID: PMC4058447 DOI: 10.1186/1471-2334-14-304] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Accepted: 05/30/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Optimal timing for initiating highly active antiretroviral therapy (HAART) in HIV-TB coinfected patients is challenging for clinicians. We aim to evaluate the impact of different timing of HAART initiation on TB outcome of HIV-infected adults in Taiwan. METHODS A population-based retrospective cohort study was conducted through linking the HIV and TB registries of Taiwan Centers for Disease Control (CDC) during 1997 to 2006. Clinical data of HIV-TB co-infected patients, including the presence of immune reconstitution inflammatory syndrome (IRIS), was collected through medical records review. The outcome of interest was all-cause mortality within 1 year following TB diagnosis. The Cox proportional hazard model was used to explore the probability of death and IRIS after TB diagnosis by adjusting for confounding factors and factors of interest. The probability of survival and TB IRIS were calculated by the Kaplan-Meier method and compared between different HAART initiation timing groups by the log-rank test. RESULTS There were 229 HIV-TB co-infected patients included for analysis and 60 cases (26.2%) died within one year. Besides decreasing age and increasing CD4 lymphocyte count, having started HAART during TB treatment was significantly associated with better survival (adjusted Hazard Ratio was 0.11, 95% CI 0.06-0.21). As to the timing of HAART initiation, there was only non-significant benefit on survival among cases initiating HAART within 15 days, at 16-30 days and at 31-60 days of TB treatment than initiating after 60 days. Cases with HAART initiated after 30 days had lower risk in developing IRIS than cases with HAART initiated earlier. Cases with IRIS had significantly higher rate of re-hospitalization (49% vs. 4%, p < 0.001) and prolonged hospitalization (28 days vs. 18.5 days, p < 0.01). CONCLUSION The present study found that starting HAART during TB treatment is associated with better one-year survival, although earlier initiation within 60 days of TB treatment did not show statistical differences in survival than later initiation. Initiation of HAART within 30 days appeared to increase the risk of IRIS. Deferring HAART to 31-60 days of TB treatment might be optimal after considering the risks and benefits.
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Kong D, Watt JP, Marks SM, Flood JM. Timely HIV diagnosis and HIV/TB comanagement among California patients in 2008. Public Health Rep 2014; 129:170-7. [PMID: 24587552 DOI: 10.1177/003335491412900211] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE National guidelines highlight the roles of early HIV diagnosis and effective comanagement for HIV and tuberculosis (TB) to prevent mortality and morbidity from HIV-related TB. We assessed HIV diagnosis timing and HIV/TB comanagement for California HIV/TB patients. METHODS We reviewed and analyzed public health charts for California HIV/TB patients reported during 2008. HIV diagnoses fewer than three months before TB diagnosis were considered new HIV diagnoses. We determined the proportion of patients with new HIV diagnoses, risk factors for new HIV diagnoses, and proportion of patients receiving recommended CD4 cell count measurements, supervised TB therapy, and antiretroviral therapy (ART). RESULTS Of 130 HIV/TB patients, 51% had new HIV diagnoses. Foreign-born patients were more likely than U.S.-born patients to have new HIV diagnoses. Supervised TB therapy and CD4 cell count measurements followed national recommendations for 91% and 74% of patients, respectively. At least 73% of patients started ART before completing TB therapy. Compared with patients who had previous HIV diagnoses, patients with new HIV diagnoses started ART later and had lower CD4 cell counts and higher viral loads at TB diagnosis. CONCLUSIONS Although most HIV/TB patients received the recommended treatment, half had new HIV diagnoses. Compared with patients who had previous HIV diagnoses, patients with new HIV diagnoses had greater immunosuppression at TB diagnosis. A new diagnosis indicates that HIV could have been diagnosed earlier and ART or treatment for latent TB infection could have been initiated to prevent TB development.
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Affiliation(s)
- Darryl Kong
- California Department of Public Health, Center for Infectious Diseases, Division of Communicable Disease Control, Tuberculosis Control Branch, Richmond, CA ; Current affiliation: California Department of Public Health, Center for Infectious Diseases, Division of Communicable Disease Control, Immunization Branch, Richmond, CA
| | - James P Watt
- California Department of Public Health, Center for Infectious Diseases, Division of Communicable Disease Control, Tuberculosis Control Branch, Richmond, CA
| | - Suzanne M Marks
- Centers for Disease Control and Prevention, Division of Tuberculosis Elimination, Atlanta, GA
| | - Jennifer M Flood
- California Department of Public Health, Center for Infectious Diseases, Division of Communicable Disease Control, Tuberculosis Control Branch, Richmond, CA
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Ande A, McArthur C, Kumar A, Kumar S. Tobacco smoking effect on HIV-1 pathogenesis: role of cytochrome P450 isozymes. Expert Opin Drug Metab Toxicol 2013; 9:1453-64. [PMID: 23822755 PMCID: PMC4007120 DOI: 10.1517/17425255.2013.816285] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
INTRODUCTION Tobacco smoking is highly prevalent among the HIV-1-infected population. In addition to diminished immune response, smoking has been shown to increase HIV-1 replication and decrease response to antiretroviral therapy, perhaps through drug-drug interaction. However, the mechanism by which tobacco/nicotine increases HIV-1 replication and mediates drug-drug interaction is poorly understood. AREAS COVERED In this review, the authors discuss the effects of smoking on HIV-1 pathogenesis. Since they propose a role for the cytochrome P450 (CYP) pathway in smoking-mediated HIV-1 pathogenesis, the authors briefly converse the role of CYP enzymes in tobacco-mediated oxidative stress and toxicity. Finally, the authors focus on the role of CYP enzymes, especially CYP2A6, in tobacco/nicotine metabolism and oxidative stress in HIV-1 model systems monocytes/macrophages, lymphocytes, astrocytes and neurons, which may be responsible for HIV-1 pathogenesis. EXPERT OPINION Recent findings suggest that CYP-mediated oxidative stress is a novel pathway that may be involved in smoking-mediated HIV-1 pathogenesis, including HIV-1 replication and drug-drug interaction. Thus, CYP and CYP-associated oxidative stress pathways may be potential targets to develop novel pharmaceuticals for HIV-1-infected smokers. Since HIV-1/TB co-infections are common, future study involving interactions between antiretroviral and antituberculosis drugs that involve CYP pathways would also help treat HIV-1/TB co-infected smokers effectively.
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Affiliation(s)
- Anusha Ande
- University of Missouri Kansas City, School of Pharmacy, Division of Pharmacology & Toxicology, Kansas City, MO 64108, USA
| | - Carole McArthur
- Professor, University of Missouri Kansas City, School of Dentistry, Department of Oral Biology, Kansas City, MO 64108, USA
| | - Anil Kumar
- Professor and Chair, University of Missouri Kansas City, School of Pharmacy, Division of Pharmacology & Toxicology, Kansas City, MO 64108, USA
| | - Santosh Kumar
- Assistant Professor, University of Missouri Kansas City, School of Pharmacy, Division of Pharmacology & Toxicology, 2464 Charlotte St. Kansas City, MO 64108, USA Tel: +1 816 235 5494 (Off); Fax: +1 816 235 1776;
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Ismail I, Bulgiba A. Predictors of death during tuberculosis treatment in TB/HIV co-infected patients in Malaysia. PLoS One 2013; 8:e73250. [PMID: 23951346 PMCID: PMC3741191 DOI: 10.1371/journal.pone.0073250] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Accepted: 07/19/2013] [Indexed: 11/18/2022] Open
Abstract
Background Mortality among TB/HIV co-infected patients is still high particularly in developing countries. This study aimed to determine the predictors of death in TB/HIV co-infected patients during TB treatment. Methods We reviewed medical records at the time of TB diagnosis and subsequent follow-up of all newly registered TB patients with HIV co-infection at TB clinics in the Institute of Respiratory Medicine and three public hospitals in the Klang Valley between January 2010 and September 2010. We reviewed these medical records again twelve months after their initial diagnosis to determine treatment outcomes and survival. We analysed using Kaplan-Meier and conducted multivariate Cox proportional hazards analysis to identify predictors of death during TB treatment in TB/HIV co-infected patients. Results Of the 227 patients studied, 53 (23.3%) had died at the end of the study with 40% of deaths within two months of TB diagnosis. Survival at 2, 6 and 12 months after initiating TB treatment were 90.7%, 82.8% and 78.8% respectively. After adjusting for other factors, death in TB/HIV co-infected patients was associated with being Malay (aHR 4.48; 95%CI 1.73-11.64), CD4 T-lymphocytes count < 200 cells/µl (aHR 3.89; 95% CI 1.20-12.63), three or more opportunistic infections (aHR 3.61; 95% CI 1.04-12.55), not receiving antiretroviral therapy (aHR 3.21; 95% CI 1.76-5.85) and increase per 103 total white blood cell count per microliter (aHR 1.12; 95% CI 1.05-1.20) Conclusion TB/HIV co-infected patients had a high case fatality rate during TB treatment. Initiation of antiretroviral therapy in these patients can improve survival by restoring immune function and preventing opportunistic infections.
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Affiliation(s)
- Ismawati Ismail
- Julius Centre University of Malaya, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
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Sileshi B, Deyessa N, Girma B, Melese M, Suarez P. Predictors of mortality among TB-HIV Co-infected patients being treated for tuberculosis in Northwest Ethiopia: a retrospective cohort study. BMC Infect Dis 2013; 13:297. [PMID: 23815342 PMCID: PMC3703293 DOI: 10.1186/1471-2334-13-297] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2012] [Accepted: 06/26/2013] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Tuberculosis (TB) is the leading cause of mortality in high HIV-prevalence populations. HIV is driving the TB epidemic in many countries, especially those in sub-Saharan Africa. The aim of this study was to assess predictors of mortality among TB-HIV co-infected patients being treated for TB in Northwest Ethiopia. METHODS An institution-based retrospective cohort study was conducted between April, 2009 and January, 2012. Based on TB, antiretroviral therapy (ART), and pre-ART registration records, TB-HIV co-infected patients were categorized into "On ART" and "Non-ART" cohorts. A Chi-square test and a T-test were used to compare categorical and continuous variables between the two groups, respectively. A Kaplan-Meier test was used to estimate the probability of death after TB diagnosis. A log-rank test was used to compare overall mortality between the two groups. A Cox proportional hazard model was used to determine factors associated with death after TB diagnosis. RESULTS A total of 422 TB-HIV co-infected patients (i.e., 272 On ART and 150 Non-ART patients) were included for a median of 197 days. The inter-quartile range (IQR) for On ART patients was 140 to 221 days and the IQR for Non-ART patients was 65.5 to 209.5 days. In the Non-ART cohort, more TB-HIV co-infected patients died during TB treatment: 44 (29.3%) Non-ART patients died, as compared to 49 (18%) On ART patients died. Independent predictors of mortality during TB treatment included: receiving ART (Adjusted Hazard Ratio (AHR) =0.35 [0.19-0.64]); not having initiated cotrimoxazole prophylactic therapy (CPT) (AHR = 3.03 [1.58-5.79]); being ambulatory (AHR = 2.10 [1.22-3.62]); CD4 counts category being 0-75 cells/micro liter, 75-150 cells/micro liter, or 150-250 cells/micro liter (AHR = 4.83 [1.98-11.77], 3.57 [1.48-8.61], and 3.07 [1.33-7.07], respectively); and treatment in a hospital (AHR = 2.64 [1.51-4.62]). CONCLUSIONS Despite the availability of free ART from health institutions in Northwest Ethiopia, mortality was high among TB-HIV co-infected patients, and strongly associated with the absence of ART during TB treatment. In addition cotrimoxazol prophylactic therapy remained important factor in reduction of mortality during TB treatment. The study also noted importance of early ART even at higher CD4 counts.
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Affiliation(s)
- Balewgizie Sileshi
- Department of Epidemiology and Biostatistics, College of Health Sciences, Haramaya University, Harar, Ethiopia
| | - Negussie Deyessa
- Department of Epidemiology and Biostatistics, School of Public health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Belaineh Girma
- Help Ethiopia Address Low TB (HEAL TB) Project, USAID/Management Sciences for Health (MSH), Addis Ababa, Ethiopia
| | - Muluken Melese
- Help Ethiopia Address Low TB (HEAL TB) Project, USAID/Management Sciences for Health (MSH), Addis Ababa, Ethiopia
| | - Pedro Suarez
- Management Sciences for Health (MSH), Arlington, Virginia, USA
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Rabirad N, Mohammad Nejad E, Hadizadeh MR, Begjan J, Ehsani SR. The Prevalence of Tb in HIV Patients and Risk Factor With Frequent Referral (Iran, 2009-10). IRANIAN RED CRESCENT MEDICAL JOURNAL 2013; 15:58-61. [PMID: 23487151 PMCID: PMC3589780 DOI: 10.5812/ircmj.4401] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/07/2012] [Revised: 07/25/2012] [Accepted: 09/13/2012] [Indexed: 11/16/2022]
Abstract
Background HIV infection significantly increases the risk of tuberculosis and this disease is one of the most common opportunistic infections in HIV Patients. Objectives The aim of this study was to determine of the prevalence of tuberculosis and risk factor among HIV patients. Materials and Methods In this cross-sectional study, from September 2009 to September 2010, 71 HIV patients who referred to teaching hospital in Tehran, Capital Iran were enrolled. Records of patients that admitted to hospital at least once a year and have positive test for HIV with ELISA and Western Blot were assessed. TB diagnosis testes included clinical finding, chest X-Ray and culture positive sputum. Results 74.6 % and 38 % of them had prison history and history of addiction respectively, 28.2% of subjects co- infected with HIV / TB and 40% of patients were under treatment with anti-retroviral drugs. There was relationship Between TB and CD4 counts below 200 cells per micro-liters (P = 0.003), age (P = 0.000), anti-retroviral drugs (P = 0.001), discharge status (P = 0.004), prison history (P = 0.002) and alcohol and smoking (P = 0.01). Conclusions The prevalence rate of TB / HIV among intravenous drug abusers and prisoners was high also the prevalence of tuberculosis among HIV patients.
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Affiliation(s)
- Narmela Rabirad
- Department of Infection Control, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Esmaeil Mohammad Nejad
- Department of Nursing, International Branch, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
- Corresponding author: Esmaeil Mohammad Nejad, First Floor, No. 9, Kavusi Alley, Urmia St, South Eskandari St, Tehran, IR Iran. Tel.: +98-2166936626, Fax: +98-2166936626, E-mail:
| | | | - Jamaloddin Begjan
- Department of Nursing, Faculty of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Seyyedeh Roghayeh Ehsani
- Department of Nursing, Imam Khomeini Clinical and Hospital Complex, Tehran University of Medical Sciences, Tehran, IR Iran
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