Increased Survival of Persons with Tuberculosis and Human Immunodeficiency Virus Infection, 1991–2000

Leonard, Michael; Larsen, Nina; Drechsler, Henning; Blumberg, Henry M.; Lennox, Jeffrey L.; Arrellano, Martha; Filip, Jennifer; Horsburgh, C. Robert

doi:10.1086/339448

Cited by 34 publications

(22 citation statements)

References 19 publications

(15 reference statements)

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“…17,18 In the absence of US autopsy studies, one US study using smears at death and tissue cultures found that 22% of a 1997 TB-HIV cohort died, 44% of which were from TB. 7 A random sample (n = 20) record review of the cause of TBassociated deaths during 2000-2004 in California found that 85% (n = 17) were definitely or possibly TB-related and that 60% (n = 12) could have been prevented; death certificate data were often inaccurate in determining the cause of death. 19 Reviews of medical records and other data, in the absence of autopsies, could improve the determination of the cause of TBassociated mortalities, 19 and improve the completeness of data on excess alcohol use, injecting drug use, non-injecting drug use, homelessness, and residence in a long-term care facility or correctional facility.…”

Section: Limitationsmentioning

confidence: 99%

“…2 Several studies document that HIV-infected TB patients on antiretroviral therapy (ART) during TB therapy survive for longer than those not on ART. [3][4][5][6][7] The present study describes trends in mortality and characteristics associated with TB diagnosis at death or death during TB therapy. We also describe diagnostic procedures for patients diagnosed at death to assess missed opportunities for prevention.…”

mentioning

confidence: 99%

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Patients diagnosed with tuberculosis at death or who died during therapy: association with the human immunodeficiency virus

Magee²,

Robison³

2011

int j tuberc lung dis

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SUMMARY OBJECTIVES-To describe trends and risk factors for tuberculosis (TB) mortality.DESIGN-We calculated trends, identified patient characteristics associated with TB diagnosis at death or death during TB treatment, and described diagnostic procedures using the United States National TB Surveillance System for 1997-2005. RESULTS-Human immunodeficiency virus (HIV)infected TB patients had an adjusted odds ratio (aOR) of 4-11 for TB diagnosis at death (foreign-born non-Whites, aOR = 11) and of 3-19 for death during TB treatment vs. non-HIV-infected patients. Odds increased by age. Hispanic males had an aOR of 2 for TB diagnosis at death compared with female non-Hispanics. Multidrug-resistant TB (MDR-TB) patients had a three times greater aOR of death during treatment than non-MDR patients. American Indians, Black females, residents in long-term care facilities, US-born patients, and non-HIV-infected homeless persons aged 25-44 years each had an aOR of 2 for mortality during treatment; 86% of pulmonary patients diagnosed at death had a chest radiograph, but 34% had no sputum smear or culture reported. [1997][1998][1999][2000][2001][2002][2003][2004][2005], controlling for age, HIV remained the characteristic with the greatest aOR for TB diagnosis at death or death during TB therapy. Race/ethnicity, country of birth and homelessness further increased the adjusted odds of death. Results show possible missed opportunities for TB diagnosis prior to death. Keywords tuberculosis; mortality; HIV TUBERCULOSIS (TB) remains a potentially deadly disease, especially for those living with human immunodeficiency virus (HIV) infection. Deaths can occur prior to TB diagnosis or during TB treatment. CONCLUSION-DuringThe most recent publication on TB mortality (diagnosis at death) using the United States National TB Surveillance System (NTSS) was in 1991, before HIV infection was reported in Correspondence to: Suzanne Marks, Centers for Disease Control and Prevention/National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention/Division of Tuberculosis Elimination, Mailstop E-10, 1600 Clifton Road, NE Atlanta, GA 30333, USA. Tel: (+1) 404 639 5343. Fax: (+1) 404 639 8961. smarks@cdc.gov. A clinical trial of TB patients enrolled after 2 months of treatment during 1995-1998 found that 7% died during therapy or during the 2-year follow-up; those who died (vs. those who survived) were more likely to have malignancy (aOR 5.3), to be HIV-infected (aOR 3.9), to use alcohol daily (aOR 2.9), to be unemployed (aOR 2.0), and to be older (aOR 1.1). 2 Several studies document that HIV-infected TB patients on antiretroviral therapy (ART) during TB therapy survive for longer than those not on ART. [3][4][5][6][7] The present study describes trends in mortality and characteristics associated with TB diagnosis at death or death during TB therapy. We also describe diagnostic procedures for patients diagnosed at death to assess missed opportunities for prevention. HHS Public Access METHODSIn the NTSS, there are two mortality outcomes associa...

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Section: Limitationsmentioning

confidence: 99%

mentioning

confidence: 99%

Patients diagnosed with tuberculosis at death or who died during therapy: association with the human immunodeficiency virus

Magee²,

Robison³

2011

int j tuberc lung dis

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“…Conversely, the diagnosis of TB can lead to life-saving HIV=AIDS care. 13,[18][19][20] However, many persons with TB=HIV have advanced HIV disease at the time of TB presentation, and frequently are either unaware of their HIV status, or are not receiving HIV care. 19,21 TB=HIV coinfected patients in North America are also more likely to have social problems complicating care, including homelessness, illicit drug use, unemployment, or incarceration, which may further complicate their ability to access HIV-specific care.…”

Section: Introductionmentioning

confidence: 99%

“…13,[18][19][20] However, many persons with TB=HIV have advanced HIV disease at the time of TB presentation, and frequently are either unaware of their HIV status, or are not receiving HIV care. 19,21 TB=HIV coinfected patients in North America are also more likely to have social problems complicating care, including homelessness, illicit drug use, unemployment, or incarceration, which may further complicate their ability to access HIV-specific care. 13 Patients with TB in North Carolina are almost exclusively managed through the public health system, so understanding the barriers to care and outcomes in coinfected patients is vital to improving the quality of care in our state, and relevant to other large public health programs in other areas.…”

Section: Introductionmentioning

confidence: 99%

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

Gadkowski

Hamilton

Allen³

et al. 2009

AIDS Patient Care and STDs

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Persons coinfected with tuberculosis (TB) and HIV are at high risk of death, in part due to suboptimal utilization of HIV-specific health care. We sought to better understand HIV-associated health care utilization and mortality in a retrospective cohort of TB=HIV coinfected cases reported in North Carolina 1993. In this cohort, HIV was newly diagnosed during TB presentation for 34.2% of coinfected patients. Patients had advanced HIV (median CD4 104 cells=mm 3 ) at TB diagnosis. Of 260 patients previously known to be HIV positive, 32.3% had seen a physician for HIV care in the previous 6 months and only 18.5% were taking antiretrovirals when TB was diagnosed; 34.8% of patients started antiretrovirals during TB treatment. Twenty-seven (5%) patients died prior to starting TB treatment; of those who survived, 13.6% (70=515) died prior to completing TB treatment, and 42.7% (220=515) died during a median 1408 days of follow-up. CD4 count (relative risk [RR] 0.53 per 100 cell increase, 95% confidence interval [CI] 0.34, 1.02) and highly active antiretroviral therapy (HAART) use during TB therapy (RR 0.37, 95% CI 0.13, 1.02) were independently associated with decreased mortality, while age greater than 45 (RR 2.18, 95% CI 1.11, 4.29) was independently associated with increased mortality during TB treatment. We conclude that TB=HIV coinfected patients had low utilization rates of HIV-specific care prior to TB diagnosis. Many did not receive potentially lifesaving HIV treatment while on TB therapy, and mortality was high as a result. Interventions to enhance utilization of HIV-related health care and integration of TB and HIV services should be studied to improve outcomes.

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“…The increasing linkage of TB with the human immunodeficiency virus (HIV) pandemic has magnified this tragedy in the past decade. The World Health Organization estimates that at least six million people worldwide are coinfected with M. tuberculosis and HIV (18). The HIV-M. tuberculosis coinfection rates exceed 5% in eight African countries, and in South Africa alone two million adults are coinfected (9).…”

mentioning

confidence: 99%

Immunization with a DNA Vaccine Cocktail Protects Mice Lacking CD4 Cells against an Aerogenic Infection withMycobacterium tuberculosis

Derrick¹,

Repique²,

Snoy

et al. 2004

Infect Immun

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Increased Survival of Persons with Tuberculosis and Human Immunodeficiency Virus Infection, 1991–2000

Cited by 34 publications

References 19 publications

Patients diagnosed with tuberculosis at death or who died during therapy: association with the human immunodeficiency virus

Patients diagnosed with tuberculosis at death or who died during therapy: association with the human immunodeficiency virus

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

Immunization with a DNA Vaccine Cocktail Protects Mice Lacking CD4 Cells against an Aerogenic Infection withMycobacterium tuberculosis

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