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Home >> Publications >> Duration of anti-tuberculosis therapy and timing of antiretroviral therapy initiation: association with mortality in HIV-related tuberculosis.

Publication

Author(s):

Cortes CP, Wehbe FH, McGowan CC, Shepherd BE, Duda SN, Jenkins CA, Gonzalez E, Carriquiry G, Schechter M, Padgett D, Cesar C, Madero JS, Pape JW, Masys DR, Sterling TR; Caribbean, Central American, South American Network for HIV Research of the International Epidemiologic Databases to Evaluate AIDS.

Pub Title:

Duration of anti-tuberculosis therapy and timing of antiretroviral therapy initiation: association with mortality in HIV-related tuberculosis.

Pub Date:

Sep 16 2013

Journal:

Title: 
PLoS One
Link: 
http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0074057

PubMed: 24066096
Pub PDF:

Abstract
BACKGROUND:
Antiretroviral therapy (ART) decreases mortality risk in HIV-infected tuberculosis patients, but the effect of the duration of anti-tuberculosis therapy and timing of anti-tuberculosis therapy initiation in relation to ART initiation on mortality, is unclear.

METHODS: We conducted a retrospective observational multi-center cohort study among HIV-infected persons concomitantly treated with Rifamycin-based anti-tuberculosis therapy and ART in Latin America. The study population included persons for whom 6 months of anti-tuberculosis therapy is recommended.

RESULTS: Of 253 patients who met inclusion criteria, median CD4+ lymphocyte count at ART initiation was 64 cells/mm(3), 171 (68%) received >180 days of anti-tuberculosis therapy, 168 (66%) initiated anti-tuberculosis therapy before ART, and 43 (17%) died. In a multivariate Cox proportional hazards model that adjusted for CD4+ lymphocytes and HIV-1 RNA, tuberculosis diagnosed after ART initiation was associated with an increased risk of death compared to tuberculosis diagnosis before ART initiation (HR 2.40; 95% CI 1.15, 5.02; P = 0.02). In a separate model among patients surviving >6 months after tuberculosis diagnosis, after adjusting for CD4+ lymphocytes, HIV-1 RNA, and timing of ART initiation relative to tuberculosis diagnosis, receipt of >6 months of anti-tuberculosis therapy was associated with a decreased risk of death (HR 0.23; 95% CI 0.08, 0.66; P=0.007).

CONCLUSIONS: The increased risk of death among persons diagnosed with tuberculosis after ART initiation highlights the importance of screening for tuberculosis before ART initiation. The decreased risk of death among persons receiving > 6 months of anti-tuberculosis therapy suggests that current anti-tuberculosis treatment duration guidelines should be re-evaluated.

PMID: 24066096 [PubMed - in process]
PMCID: PMC3774609
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Citation:

Cortes CP, Wehbe FH, McGowan CC, Shepherd BE, Duda SN, Jenkins CA, Gonzalez E, Carriquiry G, Schechter M, Padgett D, Cesar C, Madero JS, Pape JW, Masys DR, Sterling TR; Caribbean, Central American, South American Network for HIV Research of the International Epidemiologic Databases to Evaluate AIDS. Duration of anti-tuberculosis therapy and timing of antiretroviral therapy initiation: association with mortality in HIV-related tuberculosis. PLoS One. 2013 Sep 16;8(9):e74057. doi: 10.1371/journal.pone.0074057. PubMed PMID: 24066096; PubMed Central PMCID: PMC3774609.