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Home >> Publications >> Tuberculosis and the risk of opportunistic infections and cancers in HIV-infected patients starting ART in Southern Africa.

Publication

Author(s):

Fenner L, Reid SE, Fox MP, Garone D, Wellington M, Prozesky H, Zwahlen M, Schomaker M, Wandeler G, Kancheya N, Boulle A, Wood R, Henostroza G, Egger M; IeDEA Southern Africa.

Pub Title:

Tuberculosis and the risk of opportunistic infections and cancers in HIV-infected patients starting ART in Southern Africa.

Pub Date:

Feb 28 2013

Pub Region(s):

Southern Africa

Journal Issue:

18

Page Number:
194-8

Journal:

Title: 
Tropical Medicine and International Health
Link: 
http://onlinelibrary.wiley.com/doi/10.1111/tmi.12026/abstract

PubMed: 23199369
Pub PDF:

Abstract
OBJECTIVES
: To investigate the incidence of selected opportunistic infections (OIs) and cancers and the role of a history of tuberculosis (TB) as a risk factor for developing these conditions in HIV-infected patients starting antiretroviral treatment (ART) in Southern Africa.

METHODS: Five ART programmes from Zimbabwe, Zambia and South Africa participated. Outcomes were extrapulmonary cryptococcal disease (CM), pneumonia due to Pneumocystis jirovecii (PCP), Kaposi's sarcoma and Non-Hodgkin lymphoma. A history of TB was defined as a TB diagnosis before or at the start of ART. We used Cox models adjusted for age, sex, CD4 cell count at ART start and treatment site, presenting results as adjusted hazard ratios (aHR) with 95% confidence intervals (CI).

RESULTS: We analysed data from 175,212 patients enrolled between 2000 and 2010 and identified 702 patients with incident CM (including 205 with a TB history) and 487 with incident PCP (including 179 with a TB history). The incidence per 100 person-years over the first year of ART was 0.48 (95% CI 0.44-0.52) for CM, 0.35 (95% CI 0.32-0.38) for PCP, 0.31 (95% CI 0.29-0.35) for Kaposi's sarcoma and 0.02 (95% CI 0.01-0.03) for Non-Hodgkin lymphoma. A history of TB was associated with cryptococcal disease (aHR 1.28, 95% CI 1.05-1.55) and Pneumocystis jirovecii pneumonia (aHR 1.61, 95% CI 1.27-2.04), but not with Non-Hodgkin lymphoma (aHR 1.09, 95% CI 0.45-2.65) or Kaposi's sarcoma (aHR 1.02, 95% CI 0.81-1.27).

CONCLUSIONS: Our study suggests that there may be interactions between different OIs in HIV-infected patients.

© 2012 Blackwell Publishing Ltd.

PMID: 23199369 [PubMed - indexed for MEDLINE]

PMCID: PMC3553249 [Available on 2014/2/1]

 

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Citation:

Fenner L, Reid SE, Fox MP, Garone D, Wellington M, Prozesky H, Zwahlen M, Schomaker M, Wandeler G, Kancheya N, Boulle A, Wood R, Henostroza G, Egger M; IeDEA Southern Africa. Tuberculosis and the risk of opportunistic infections and cancers in HIV-infected patients starting ART in Southern Africa. Trop Med Int Health. 2013 Feb;18(2):194-8. doi: 10.1111/tmi.12026. Epub 2012 Nov 30. PubMed PMID: 23199369; PubMed Central PMCID: PMC3553249.