Causes of death in hospitalized adults with a premortem diagnosis of tuberculosis: an autopsy study

Martinson, Neil; Karstaedt, Alan; Venter, François; Touzani, Omar; King, P Poon; Mbengo, Tumi; Marais, Elsé; McIntyre, James; Chaisson, Richard E.; Hale, Martin

doi:10.1097/qad.0b013e3282eea47f

Cited by 99 publications

(92 citation statements)

References 34 publications

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“…8, 9 They have consistently been shown to be major causes of death among HIV-infected patients in settings where access to diagnosis and treatment is low. [10][11][12][13][14][15][16] These diseases triggered the question "Should we start ART earlier?" in low-income countries.…”

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confidence: 99%

A Trial of Early Antiretrovirals and Isoniazid Preventive Therapy in Africa

2015

N Engl J Med

1,020

447

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BACKGROUND: In sub-Saharan Africa, the burden of human immunodeficiency virus (HIV)-associated tuberculosis is high. We conducted a trial with a 2-by-2 factorial design to assess the benefits of early antiretroviral therapy (ART), 6-month isoniazid preventive therapy (IPT), or both among HIV-infected adults with high CD4+ cell counts in Ivory Coast. METHODS: We included participants who had HIV type 1 infection and a CD4+ count of less than 800 cells per cubic millimeter and who met no criteria for starting ART according to World Health Organization (WHO) guidelines. Participants were randomly assigned to one of four treatment groups: deferred ART (ART initiation according to WHO criteria), deferred ART plus IPT, early ART (immediate ART initiation), or early ART plus IPT. The primary end point was a composite of diseases included in the case definition of the acquired immunodeficiency syndrome (AIDS), non-AIDS-defining cancer, non-AIDS-defining invasive bacterial disease, or death from any cause at 30 months. We used Cox proportional models to compare outcomes between the deferred-ART and early-ART strategies and between the IPT and no-IPT strategies. RESULTS: A total of 2056 patients (41% with a baseline CD4+ count of ≥500 cells per cubic millimeter) were followed for 4757 patient-years. A total of 204 primary end-point events were observed (3.8 events per 100 person-years; 95% confidence interval [CI], 3.3 to 4.4), including 68 in patients with a baseline CD4+ count of at least 500 cells per cubic millimeter (3.2 events per 100 person-years; 95% CI, 2.4 to 4.0). Tuberculosis and invasive bacterial diseases accounted for 42% and 27% of primary end-point events, respectively. The risk of death or severe HIV-related illness was lower with early ART than with deferred ART (adjusted hazard ratio, 0.56; 95% CI, 0.41 to 0.76; adjusted hazard ratio among patients with a baseline CD4+ count of ≥500 cells per cubic millimeter, 0.56; 95% CI, 0.33 to 0.94) and lower with IPT than with no IPT (adjusted hazard ratio, 0.65; 95% CI, 0.48 to 0.88; adjusted hazard ratio among patients with a baseline CD4+ count of ≥500 cells per cubic millimeter, 0.61; 95% CI, 0.36 to 1.01). The 30-month probability of grade 3 or 4 adverse events did not differ significantly among the strategies. CONCLUSIONS: In this African country, immediate ART and 6 months of IPT independently led to lower rates of severe illness than did deferred ART and no IPT, both overall and among patients with CD4+ counts of at least 500 cells per cubic millimeter. (Funded by the French National Agency for Research on AIDS and Viral Hepatitis; TEMPRANO ANRS 12136 ClinicalTrials.gov number, NCT00495651.)

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confidence: 99%

A Trial of Early Antiretrovirals and Isoniazid Preventive Therapy in Africa

2015

N Engl J Med

1,020

447

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“…was detected only postmortem (Berdnikov et al, 2011). Both false positive as well as false negative antemortem diagnoses are described (Martinson et al, 2007). Infections such tuberculosis, Cytomegalovirus and invasive mycoses are missed with the highest rate (Antinori et al, 2009;Beadsworth et al, 2009;Eza et al, 2006;Tang et al, 2006;Wilkes et al, 1988).…”

Section: Resultsmentioning

confidence: 99%

Pathology of HIV/AIDS: Lessons from Autopsy Series

Bychkov¹,

Yamashita²,

Доросевич³

2011

HIV and AIDS - Updates on Biology, Immunology, Epidemiology and Treatment Strategies

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“…In Mozambique, children aged 15 years and below recorded childhood bacteremia cases as high as 120 per 100,000 persons/year (Feasey et al, 2010). Despite the fact that NTS cases are usually underreported, 1,318 cases of infective NTS were microbiologically confirmed in South Africa between years 2003 and 2004, with S. typhimurium and S. enteritidis as the most common serovars (Martinson et al, 2007). In addition, an autopsy study was carried out on 50 patients who died with a pre-mortem clinical diagnosis of tuberculosis.…”

Section: Epidemiology Of Human Non-typhoidal Salmonellosismentioning

confidence: 99%

Untitled

2017

IRJPEH

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The impact of non-typhoidal Salmonella (NTS) infections on human and animal health, with the associated morbidity and mortality is a global issue of public health concern. The socioeconomic conditions in the developing countries particularly the sub-Saharan Africa seem to further aggravate the rate and seriousness of the infections. Thus the endemicity of NTS infections to sub-Saharan Africa as well as the resistance of the NTS strains to both antimicrobials and environmental stress is shown in this review. The association of Salmonella virulence plasmids with both antibiotic and stress resistance genes could play a major role in the persistence and spread of the resistance and virulence genes in Salmonella and other related pathogens. This may constitute a serious public health challenge in resource-limited rural African settings.

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Causes of death in hospitalized adults with a premortem diagnosis of tuberculosis: an autopsy study

Cited by 99 publications

References 34 publications

A Trial of Early Antiretrovirals and Isoniazid Preventive Therapy in Africa

A Trial of Early Antiretrovirals and Isoniazid Preventive Therapy in Africa

Pathology of HIV/AIDS: Lessons from Autopsy Series

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