HIV-Specific Health Care Utilization and Mortality among Tuberculosis/HIV Coinfected Persons

Gadkowski, L. Beth; Hamilton, Carol; Allen, M. Brandon; Fortenberry, Ellen R; Luffman, Julie; Zeringue, Elizabeth; Stout, Jason E.

doi:10.1089/apc.2009.0030

Cited by 11 publications

(13 citation statements)

References 28 publications

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“…In our study, patients with CD4 T-lymphocytes count lower than 200 cells/µl had almost four times higher risk of death compared to those with CD4 T-lymphocytes count more than 200 cells/µl (HR 3.89; 95% CI: 1.20-12.63). This finding is well established in other previous studies [5,24,25,30,31,33,39,40]. The mean survival time of patients with CD4 < 200 cells/µl is 17.0 months (95% CI: 15.8-18.2) which is lower than the mean survival time for patients with CD4 > 200 cells/µl (20.0 months; 95% CI: 18.7-21.1).…”

Section: Discussionsupporting

confidence: 91%

Predictors of Death during Tuberculosis Treatment in TB/HIV Co-Infected Patients in Malaysia

Ismail

Bulgiba

2013

PLoS ONE

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BackgroundMortality 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.MethodsWe 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.ResultsOf 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)ConclusionTB/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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Section: Discussionsupporting

confidence: 91%

Predictors of Death during Tuberculosis Treatment in TB/HIV Co-Infected Patients in Malaysia

Ismail

Bulgiba

2013

PLoS ONE

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“…Such association may be a result of late diagnosis of HIV or of underutilization of health care by subjects with known HIV infection [27]. This finding also underscores a relevant logistical challenge for the adequate care of TB/HIV patients.…”

Section: Discussionmentioning

confidence: 77%

Factors Impacting Early Mortality in Tuberculosis/HIV Patients: Differences between Subjects Naïve to and Previously Started on HAART

et al. 2012

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BackgroundMortality among patients with tuberculosis (TB)/HIV is highest during the first few months of antituberculous therapy. The objective of this study was to assess the factors associated with early mortality among TB/HIV patients and whether these factors are similar for HAART naïve and those with prior HAART initiation.MethodsProspective cohort study including HIV patients with tuberculosis confirmed by culture, cared for at a referral center in Rio de Janeiro, Brazil. Multivariable Cox analysis was used to assess predictors of mortality within 3 months of antituberculous therapy.ResultsAmong 227 patients included, 90 (40%) started HAART before TB diagnosis. The median time to TB diagnosis after ARV initiation was 5.9 months (interquartile range [IQR] 3.0–8.9 months). Fourteen patients (6%) died within the first 3 months. Mortality was not different between patients previously started on HAART and those who were naïve to it. In the overall adjusted analysis, HAART use during TB treatment (hazard ratio [HR] = 0.21, 95% confidential interval [CI] = 0.06–0.72) and CD4 lymphocyte count >100 cells/mm3 (HR = 0.21, 95% CI = 0.04–0.99) were associated with lower mortality, while subjects with unknown baseline CD4 lymphocyte count (HR = 9.39, 95% CI = 2.56–34.5) had higher mortality. In subgroup analysis, among HAART naïve subjects, disseminated TB (HR = 5.32, 95% CI = 1.09–25.8) and unknown baseline CD4 lymphocyte count (HR = 13.2, 95% CI = 2.71–64.5) were associated with significantly higher mortality, while HAART (HR = 0.14, 95% CI = 0.03–0.69) predicted a better outcome. Among subjects previously started on HAART, mortality was significantly associated with duration of TB symptoms >120 days (HR = 6.15, 95% CI = 1.15–32.9).ConclusionsPredictors of early mortality among TB/HIV patients may vary according to the timing of HAART initiation. Among HAART naïve patients, mortality was influenced by baseline clinical severity, HAART use and, possibly, the quality of care preceding TB diagnosis. For patients with prior HAART initiation, longer delays in TB diagnosis predicted a significantly higher mortality.

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“…Furthermore, although HAART is freely available in Taiwan, there are some HIV-infected patients who do not link into HIV-related medical care [26]. The barrier between HIV-TB co-infected patients and medical services is also reported in other studies [27,28]. In mid-2013, the National TB program launch a project to have every TB patient aged 15–49 years complete HIV test.…”

Section: Discussionmentioning

confidence: 98%

The impact of HAART initiation timing on HIV-TB co-infected patients, a retrospective cohort study

et al. 2014

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BackgroundOptimal 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.MethodsA 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.ResultsThere 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).ConclusionThe 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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HIV-Specific Health Care Utilization and Mortality among Tuberculosis/HIV Coinfected Persons

Cited by 11 publications

References 28 publications

Predictors of Death during Tuberculosis Treatment in TB/HIV Co-Infected Patients in Malaysia

Predictors of Death during Tuberculosis Treatment in TB/HIV Co-Infected Patients in Malaysia

Factors Impacting Early Mortality in Tuberculosis/HIV Patients: Differences between Subjects Naïve to and Previously Started on HAART

The impact of HAART initiation timing on HIV-TB co-infected patients, a retrospective cohort study

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