Breakthrough tuberculosis disease among people with HIV – Should we be worried? A retrospective longitudinal study

Yirdaw, Kesetebirhan Delele; Teklu, Alula M.; Mamuye, Admasu Tenna; Zewdu, Solomon

doi:10.1371/journal.pone.0211688

Cited by 11 publications

(13 citation statements)

References 22 publications

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“…PLHIV who were on HAART had 87% reduced risk of EPTB compared to those who were not enrolled on HAART (AHR = 0.134, 95%CI = 0.075-0.238). In line with this, other studies also reported the significant decrease risk of EPTB among HIV positive individuals who were enrolled on HAART [6,22,30,[32][33][34][35].…”

Section: Discussionsupporting

confidence: 73%

“…Immune status is a key factor for the susceptibility of a host for TB, such that when the immune system becomes week the likely hood to be infected with TB increases [6] [24]. Based on this study and findings from previous studies done in Ethiopia and other countries, individuals who had lower CD4 count at the time of enrollment had higher risk to develop TB [2,6,14,20,21,23,[26][27][28][29][30][31][32][33]. The other independent predictor of EPTB observed in this study was the baseline hemoglobin value.…”

Section: Discussionmentioning

confidence: 84%

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Incidence and predictors of extrapulmonary tuberculosis among people living with Human Immunodeficiency Virus in Addis Ababa, Ethiopia: A retrospective cohort study

et al. 2020

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Background Extrapulmonary tuberculosis is an emerging public health problem among HIV positives compared to the general population. This study aimed to assess the incidence and predictors of extrapulmonary tuberculosis among people living with HIV in selected health facilities in Addis Ababa, Ethiopia, from 01 January 2013 up to 31 December 2018. Methods A retrospective cohort study design was employed based on data collected from 566 HIV positive individuals. Data were entered using EpiInfo version 7.1 and analyzed by SPSS version 20. The incidence rate was determined per 100 person-years. Kaplan-Meier estimates used to estimate survivor and the hazard function, whereas log-rank tests used to compare survival curves and hazard across different categories. Cox proportional hazard model was used to identify the predictors and 95%CI of the hazard ratio were computed. P-value<0.05 in the multivariable analysis was considered statistically significant. Results Five hundred sixty-six HIV positive individuals were followed for 2140.08 person-years. Among them, 72 developed extrapulmonary tuberculosis that gives an incidence rate of 3.36/100 person-years (95%CI = 2.68-4.22). The most frequent forms of extrapulmonary tuberculosis were; lymph node tuberculosis (56%, 41) followed equally by pleural tuberculosis (15%, 11) and disseminated tuberculosis (15%, 11). The majority (70.83%) of the cases occurred within the first year of follow-up. In multivariable Cox regression analysis, baseline WHO stage III/IV (AHR = 2.720, 95%CI = 1.575-4.697), baseline CD4 count<50cells/μl (AHR = 4.073, 95%CI = 2.064-8.040), baseline CD4 count 50-200 cells/μl (AHR = 2.360, 95%CI = 1.314-4.239) and baseline Hgb<10 mg/dl (AHR = 1.979, 95%CI = 1.091-3.591) were the independent risk factors. While isoniazid prophylaxis (AHR = 0.232, 95%CI =

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Section: Discussionsupporting

confidence: 73%

Section: Discussionmentioning

confidence: 84%

Incidence and predictors of extrapulmonary tuberculosis among people living with Human Immunodeficiency Virus in Addis Ababa, Ethiopia: A retrospective cohort study

et al. 2020

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“…Nonetheless, limitations related to our study include that our findings cannot be generalized to the entire population as the data is generated from the private sector and included only one study site. The diagnosis of TB in SSA setting is challenging as it is not definitive being without microbiological confirmation for all patients [14,15,21,47,49,50], as is for our cohort. All our patients received IPT for preventing TB as of 2010.…”

Section: Discussionmentioning

confidence: 97%

Role of CD4/CD8 ratio on the incidence of tuberculosis in HIV-infected patients on antiretroviral therapy followed up for more than a decade

Wolday

Kebede

Legesse³

et al. 2020

PLoS ONE

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Background The role of CD4/CD8 ratio on the incidence of tuberculosis (TB) in patients on antiretroviral therapy (ART) is unknown. Thus, we sought to determine whether the CD4/CD8 ratio was associated with development of TB in a cohort of HIV infected individuals on ART followed up for more than a decade in the setting of sub-Saharan Africa (SSA). Methods The cohort comprised adult patients who started ART between 2001 and 2007 and followed for up to 15 years. Clinical data were collected in retrospective manner. Patients with an AIDS defining illness or a CD4 count <200 cell/μL were started with a combination of ART. The participants have clinic visits every 6 months and/or as needed. Poisson regression models were used to identify factors associated with development of incident TB. Kaplan-Meier curves were used to estimate the probability of incident TB while on ART. Results A total of 347 patients with a median duration of follow-up on ART of 11.5 (IQR: 10.0-12.5) years were included. Incident TB developed in 47 patients during the 3259 person-years of follow-up, the majority (76.6%) occurred within five year of ART initiation. On univariate analysis,

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“…The dataset used in this study is publicly available through the PLOS ONE policy, and comprehensive details on the selection of study participants that provided data analysed in this study are described elsewhere [ 5 ]. The following is a brief description of the study design, population, setting, exposure variables and outcomes, data collection procedures and ethical consideration.…”

Section: Methodsmentioning

confidence: 99%

“…These methods assume non-informative censoring and failures from competing risks are treated as censored [ 2 ]. However, in the competing risks paradigm, the occurrence of competing events can result in informative censoring [ [2] , [3] , [4] , [5] , [6] ]. Failure to account for competing events may reduce statistical power, overestimate probability of outcomes of interest and result in biased inferences [ 7 , 8 , 9 ].…”

Section: Introductionmentioning

confidence: 99%

An empirical comparison of time-to-event models to analyse a composite outcome in the presence of death as a competing risk

Haushona

Esterhuizen

Thabane

et al. 2020

Contemporary Clinical Trials Communications

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Introduction Competing risks arise when subjects are exposed to multiple mutually exclusive failure events, and the occurrence of one failure hinders the occurrence of other failure events. In the presence of competing risks, it is important to use methods accounting for competing events because failure to account for these events might result in misleading inferences. Methods and Objective Using data from a multisite retrospective observational longitudinal study done in Ethiopia, we performed sensitivity analyses using Fine-Gray model, Cause-specific Cox (Cox-CSH) model, Cause-specific Accelerated Failure Time (CS-AFT) model, accounting for death as a competing risk to determine baseline covariates that are associated with a composite of unfavourable retention in care outcomes in people living with Human Immune Virus who were on both Isoniazid preventive therapy (IPT) and antiretroviral therapy (ART). Non-cause specific (non-CSH) model that does not account for competing risk was also performed. The composite outcome comprises of loss to follow-up, stopped treatment and death. Age, World Health Organisation (WHO) stage, gender, and CD4 count were the considered baseline covariates. Results We included 3578 patients in our analysis. WHO stage III-or-IV was significantly associated with the composite of unfavourable outcomes, Sub-hazard ratio (SHR) = 1.31, 95% confidence interval (CI):1.04–1.65 for the sub-distribution hazard model, hazard ratio [HR] = 1.31, 95% CI:1.05–1.65, for the Cox-CSH model, and HR = 0.81, 95% CI:0.69–0.96, for the CS-AFT model. Gender and WHO stage were found to be significantly associated with the composite of unfavourable outcomes, HR = 1.56, 95% CI:1.27–1.90, HR = 1.28, 95% CI: 1.06–1.55 for males and WHO stage III-or-IV, respectively for the non-CSH model. Conclusions Results show that WHO stage III-or-IV is significantly associated with unfavourable outcomes. The results from competing risk models were consistent. However, results obtained from the non-CSH model were inconsistent with those obtained from competing risk analysis models.

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Breakthrough tuberculosis disease among people with HIV – Should we be worried? A retrospective longitudinal study

Cited by 11 publications

References 22 publications

Incidence and predictors of extrapulmonary tuberculosis among people living with Human Immunodeficiency Virus in Addis Ababa, Ethiopia: A retrospective cohort study

Incidence and predictors of extrapulmonary tuberculosis among people living with Human Immunodeficiency Virus in Addis Ababa, Ethiopia: A retrospective cohort study

Role of CD4/CD8 ratio on the incidence of tuberculosis in HIV-infected patients on antiretroviral therapy followed up for more than a decade

An empirical comparison of time-to-event models to analyse a composite outcome in the presence of death as a competing risk

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