Survival Rate and Risk Factors of Mortality Among HIV/Tuberculosis-Coinfected Patients With and Without Antiretroviral Therapy

Manosuthi, Weerawat; Chottanapand, Suthat; Thongyen, Supeda; Chaovavanich, Achara; Sungkanuparph, Somnuek

doi:10.1097/01.qai.0000230521.86964.86

Cited by 217 publications

(180 citation statements)

References 22 publications

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“…In countries with HIV epidemics, the strongest predictor of death during TB treatment is HIV infection (Domingos et al 2008;Sanguanwongse et al 2008). Among HIV-infected patients receiving TB treatment, antiretroviral therapy is the most important determinant of survival during TB treatment (Manosuthi et al 2006;Akksilp et al 2007;Sungkanuparph et al 2007;Tansuphasawadikul et al 2007;Sanguanwongse et al 2008). A large number of epidemiologic studies have evaluated risk factors for death in HIV-uninfected patients, but most were published in the pre-HIV era or in settings with low HIV prevalence.…”

Section: Introductionmentioning

confidence: 99%

Factors associated with death among HIV‐uninfected TB patients in Thailand, 2004–2006

Amnuaiphon

Anuwatnonthakate

Nuyongphak

et al. 2009

Tropical Med Int Health

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Summaryobjectives In countries with both TB and human immunodeficiency virus (HIV) epidemics, HIV is known to be the most powerful risk factor for death during tuberculosis (TB) treatment. Few recent studies have evaluated risk factors for death among HIV-uninfected TB patients in these countries. We analysed data from a multi-province demonstration project in Thailand to answer this question.method We prospectively collected data from HIV-uninfected TB patients treated for TB in four provinces and the national infectious diseases hospital in Thailand from [2004][2005][2006]. Standard WHO definitions were used to classify treatment outcomes. We used log-binomial multivariate regression to calculate adjusted relative risk (aRR) and 95% confidence intervals (CI) for factors associated with death.

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Section: Introductionmentioning

confidence: 99%

Factors associated with death among HIV‐uninfected TB patients in Thailand, 2004–2006

Amnuaiphon

Anuwatnonthakate

Nuyongphak

et al. 2009

Tropical Med Int Health

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“…Autopsies are not routinely performed in HIV-infected persons in Asia, and data from Africa may not be generalizable to Asia. Malaria is much less common in Asia than in Africa, and HIV-infected TB patients have more severe immunosuppression and higher death rates than patients in Africa (2)(3)(4)(6)(7)(8)(9)(14)(15)(16)(17)(18)(19). Understanding actual causes of death may help with identifying effective interventions.…”

mentioning

confidence: 99%

“…In Southeast Asia, the death rate for HIV-infected TB patients during TB treatment is particularly high, ranging from 20% to 50% (2)(3)(4)(5). HIV-infected patients in Southeast Asia are severely immunocompromised at the time of TB diagnosis, with a median CD4+ T-cell lymphocyte count (CD4) of 54-57 cells/μL (2,(6)(7)(8)(9). With this degree of immunosuppression, it is likely, but not known, that opportunistic infections other than TB contribute substantially to the high case-fatality rate.…”

mentioning

confidence: 99%

Causes of Death in HIV-infected Persons Who Have Tuberculosis, Thailand

Cain¹,

Anekthananon²,

Burapat³

et al. 2009

Emerg. Infect. Dis.

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Up to 50% of persons with HIV and a diagnosis of tuberculosis (TB) in Thailand die during TB treatment. In a prospective observational study, a team of physicians ascribed the cause of death after reviewing verbal autopsies (interviews of family members about events preceding death), laboratory data, and medical records. Of 849 HIVinfected TB patients enrolled, 142 (17%) died. The cause of death was TB for 38 (27%), including 6 with multidrugresistant TB and 20 with disseminated TB; an HIV-associated condition other than TB for 50 (35%); and a condition unrelated to TB or HIV for 22 (15%). Twenty-three patients (16%) were judged not to have had TB at all. Death from all causes except those unrelated to TB or HIV was less common in persons receiving antiretroviral therapy (ART). In addition to increasing the use of ART, death rates may be reduced through expanded use of modern TB diagnostic techniques.

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“…These coinfections are not only widespread and increase mortality rates, but they also reduce the accuracy of HIV tests [62,[65][66][67][68][69], creating a need for diagnostics that can quickly and reliably account for these coinfections. Using TB as an example, the analytical and clinical techniques used for diagnosis include sputum smear microscopy and culture, but these methods are inaccurate (microscopy misses 50% of cases) and not rapid (cultures may require days) [62,70].…”

Section: Presence Of Coinfectionsmentioning

confidence: 99%

HIV Diagnostics: Challenges and Opportunities

Wong

Hewlett

2010

HIV Ther.

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Accurate HIV diagnostic testing continues to pose challenges, but there are also opportunities for assay performance improvements in key areas for specific intended-use settings. The genetic diversity of HIV can result in false and discordant results in assays that fail to detect new variant strains. The use of antiretroviral therapies has resulted in drug-resistant variants that require monitoring by sequencing and genotyping methods. Nucleic acid testing is the most sensitive and reliable platform for detection, but it is costly and limited to centralized testing facilities, making implementation difficult in resource-limited settings where HIV has hit the hardest. Rapid antibody tests suitable for point-of-care use are becoming more accessible in resource-limited settings, but these tests may not detect HIV during the acute infection stage. Emerging antigen/antibody combination assays are viable alternatives to nucleic acid testing for diagnosis of recent infections. Although patient monitoring (e.g., via CD4+ T-cell count and viral load determination) and infant diagnoses still rely on clinical laboratory-based testing, point-of-care options are being developed. There are other technical challenges to HIV diagnostic testing and emerging biodetection technologies that may be able to address them, but they are not yet proven.

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Survival Rate and Risk Factors of Mortality Among HIV/Tuberculosis-Coinfected Patients With and Without Antiretroviral Therapy

Abstract: Antiretroviral therapy substantially reduces mortality rate among HIV/TB-coinfected patients. Initiation of ART within 6 months of TB diagnosis is associated with greater survival.

Cited by 217 publications

References 22 publications

Factors associated with death among HIV‐uninfected TB patients in Thailand, 2004–2006

Factors associated with death among HIV‐uninfected TB patients in Thailand, 2004–2006

Causes of Death in HIV-infected Persons Who Have Tuberculosis, Thailand

HIV Diagnostics: Challenges and Opportunities

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