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Gebrehiwet K, Biranu E, Nigatu W, Gebreegziabher A, Desta K. Prevalence of Hepatitis B Virus, Human Immune Deficiency Virus and Associated Risk Factors Among Individuals with Presumptive Pulmonary Tuberculosis Attending at Saint Peter's Specialized Hospital, Addis Ababa, Ethiopia. Infect Drug Resist 2023; 16:3965-3979. [PMID: 37366503 PMCID: PMC10290864 DOI: 10.2147/idr.s410260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 06/06/2023] [Indexed: 06/28/2023] Open
Abstract
Background Hepatitis B virus (HBV), human immunodeficiency virus (HIV) and tuberculosis are the causes of widely spread infectious disease, especially in resource-limited countries. The extent of HBV infection and its contributing factors among people with suspected pulmonary tuberculosis (PTB) were not adequately addressed. Objective To assess the prevalence of HBV, HIV & their associated risk factors and the magnitude of TB among individuals with presumptive pulmonary tuberculosis attending at St. Peter's Specialized Hospital, Addis Ababa, Ethiopia. Methods A cross-sectional study was conducted among 387 individuals with presumptive PTB from October to December 2020. A standard questionnaire was used to collect socio-demographic data and associated risk factors. Sputum samples were analyzed by GeneXpert, Florescent Microscopy and Ziehl-Nelson staining technique. HBsAg test was carried out using Murex Version 3 ELISA test kit from serum/Plasma samples, HIV testing was performed by rapid HIV test kits and data were analyzed using SPSS version 23. Results The mean age of study participants was 44.2 years. Overall, 14 (3.6%), 28 (7.2%) and 37 (9.6%) of them were positive for HBV, HIV & TB, respectively. Only single patient was HBV-HIV co-infected (0.3%). The TB-HIV co-infection was identified in 6 (1.6%). In multivariate analysis, being partner separated, alcohol consumption, body piercing and having multiple sexual partners were significantly associated with HBV infection. Having a spouse, who is divorced, widowed, sharing scissors, alcohol consumption and contact with multiple sexual partners also significantly associated with HIV infection. Conclusion This study showed that HBV, HIV and TB are still public health issues that need awareness and health education on the risky behaviors and transmission of HBV, HIV & TB among individuals with presumptive TB suspects. Further large-scale study is necessary.
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Affiliation(s)
- Kahasit Gebrehiwet
- Addis Ababa University College of Health Sciences, Department of Medical Laboratory Sciences, Addis Ababa, Ethiopia
- St. Peter’s Specialized Hospital, Addis Ababa, Ethiopia
| | | | - Wondatir Nigatu
- Ethiopian Public Health Institute, Tuberculosis /HIV Research Directorate, Addis Ababa, Ethiopia
| | | | - Kassu Desta
- Addis Ababa University College of Health Sciences, Department of Medical Laboratory Sciences, Addis Ababa, Ethiopia
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Najafi Ghobadi K, Mahjub H, Poorolajal J, Shakiba E, Khassi K, Roshanaei G. Joint Modeling of Longitudinal Outcome and Competing Risks: Application to HIV/AIDS Data. J Res Health Sci 2023; 23:e00571. [PMID: 37571942 PMCID: PMC10422140 DOI: 10.34172/jrhs.2023.106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 01/02/2023] [Accepted: 02/12/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND Tuberculosis (TB) and human immunodeficiency virus (HIV) are major public health challenges globally, and the number of TB infections and death caused by HIV are high because of HIV/ TB co-infection. On the other hand, CD4 count plays a significant role in TB/HIV co-infections. We used a joint model of longitudinal outcomes and competing risks to identify the potential risk factors and the effect of CD4 cells on TB infection and death caused by HIV in HIV-infected patients. STUDY DESIGN This was a retrospective cohort study. METHODS The current study was performed on 1436 HIV+patients referred to Behavioral Diseases Counseling Centers in Kermanshah Province during 1998-2019. In this study, joint modeling was used to identify the effect of potential risk factors and CD4 cells on TB and death caused by HIV. RESULTS The results demonstrated that the decreasing CD4 cell count was significantly associated with an increased risk of death, while it had no significant relation with the risk of TB. In addition, patients with TB were at a higher risk of death. Based on the results, a significant relationship was found between CD4 count and sex, marital status, education level, antiretroviral therapy (ART), time, and the interaction between time and ART. Further, people infected with HIV through sexual relationships were at higher risk of TB, while those with a history of imprisonment who received ART or were infected with HIV through drug injection had a lower risk of TB. CONCLUSION The findings revealed that the decreasing CD4 count had a significant association with an increased risk of death caused by HIV. However, it was not significantly related to the risk of TB. Finally, patients with TB were at higher risk of death caused by HIV.
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Affiliation(s)
- Khadijeh Najafi Ghobadi
- Department of Biostatistics, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Hossein Mahjub
- Department of Biostatistics, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
- Research Center for Health Sciences, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Jalal Poorolajal
- Department of Epidemiology, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
- Modeling of Noncommunicable Diseases Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Ebrahim Shakiba
- Behavioral Disease Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Kaivan Khassi
- Department of Health, School of Public Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Ghodratollah Roshanaei
- Department of Biostatistics, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
- Modeling of Noncommunicable Diseases Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
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Yang N, He J, Li J, Zhong Y, Song Y, Chen C. Predictors of death among TB/HIV co-infected patients on tuberculosis treatment in Sichuan, China: A retrospective cohort study. Medicine (Baltimore) 2023; 102:e32811. [PMID: 36749231 PMCID: PMC9901956 DOI: 10.1097/md.0000000000032811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Mycobacterium tuberculosis is the most common opportunistic infection among patients with human immunodeficiency virus (HIV) infection, and it is also the leading cause of death, causing approximately one-third of acquired immune deficiency syndrome deaths worldwide. China is on the World Health Organization's global list of 30 high-tuberculosis (TB) burden countries. The objective of this study was to evaluate the mortality rate, survival probabilities, and factors associated with death among patients with TB/HIV co-infection undergoing TB treatment in Sichuan, China. A retrospective cohort study was conducted using the Chinese National TB Surveillance System data of TB/HIV co-infected patients enrolled in TB treatment from January 2020 to December 2020. We calculated the mortality rate and survival probabilities using the Kaplan-Meier estimator, and a Cox proportional hazard model was conducted to identify independent risk factors for TB/HIV co-infection mortality. Hazard ratios and their respective 95% confidence intervals were also reported in this study. Of 828 TB/HIV co-infected patients, 44 (5.31%) died during TB treatment, and the crude mortality rate was 7.76 per 1000 person-months. More than half of the deaths (n = 23) occurred in the first 3 months of TB treatment. Overall survival probabilities were 97.20%, 95.16%, and 91.75% at 3rd, 6th, and 12th month respectively. The independent risk factors for mortality among TB/HIV co-infected patients were having extra-pulmonary TB and pulmonary TB co-infection, history of antiretroviral therapy interruption, and baseline cluster of differentiation 4 T-lymphocyte counts <200 cells/μL at the time of HIV diagnosis. Antiretroviral therapy is important for the survival of TB/HIV co-infected patients, and it is recommended to help prolong life by restoring immune function and preventing extra-pulmonary TB.
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Affiliation(s)
- Ni Yang
- Sichuan Center for Disease Control and Prevention, Chengdu, Sichuan, China
| | - Jinge He
- Sichuan Center for Disease Control and Prevention, Chengdu, Sichuan, China
- * Correspondence: Jinge He, Sichuan Center for Disease Control and Prevention, Chengdu, Sichuan 610041, China(e-mail: )
| | - Jing Li
- Sichuan Center for Disease Control and Prevention, Chengdu, Sichuan, China
| | - Yin Zhong
- Sichuan Center for Disease Control and Prevention, Chengdu, Sichuan, China
| | - Yang Song
- Sichuan Center for Disease Control and Prevention, Chengdu, Sichuan, China
| | - Chuang Chen
- Sichuan Center for Disease Control and Prevention, Chengdu, Sichuan, China
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Bentzon AK, Panteleev A, Mitsura V, Borodulina E, Skrahina A, Denisova E, Tetradov S, Podlasin R, Riekstina V, Kancauskiene Z, Paduto D, Mocroft A, Trofimova T, Miller R, Post F, Grezesczuk A, Lundgren JD, Inglot M, Podlekareva D, Bolokadze N, Kirk O. Healthcare delivery for HIV-positive people with tuberculosis in Europe. HIV Med 2021; 22:283-293. [PMID: 33215809 PMCID: PMC9801686 DOI: 10.1111/hiv.13016] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2020] [Indexed: 01/03/2023]
Abstract
BACKGROUND In a 2013 survey, we reported distinct discrepancies in delivery of tuberculosis (TB) and HIV services in eastern Europe (EE) vs. western Europe (WE). OBJECTIVES To verify the differences in TB and HIV services in EE vs. WE. METHODS Twenty-three sites completed a survey in 2018 (EE, 14; WE, nine; 88% response rate). Results were compared across as well as within the two regions. When possible, results were compared with the 2013 survey. RESULTS Delivery of healthcare was significantly less integrated in EE: provision of TB and HIV services at one site (36% in EE vs. 89% in WE; P = 0.034), and continued TB follow-up in one location (42% vs. 100%; P = 0.007). Although access to TB diagnostics, standard TB and HIV drugs was generally good, fewer sites in EE reported unlimited access to rifabutin/multi-drug-resistant TB (MDR-TB) drugs, HIV integrase inhibitors and opioid substitution therapy (OST). Compared with 2013, routine usage of GeneXpert was more common in EE in 2018 (54% vs. 92%; P = 0.073), as was access to moxifloxacin (46% vs. 91%; P = 0.033), linezolid (31% vs. 64%; P = 0.217), and bedaquiline (0% vs. 25%; P = 0.217). Integration of TB and HIV services (46% vs. 39%; P = 1.000) and provision of OST to patients with opioid dependency (54% vs. 46%; P = 0.695) remained unchanged. CONCLUSION Delivery of TB and HIV healthcare, including integration of TB and HIV care and access to MDR-TB drugs, still differs between WE and EE, as well as between individual EE sites.
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Affiliation(s)
- A K Bentzon
- CHIP (Centre of Excellence for Health, Immunity and Infections), Department of Infectious Disease, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - A Panteleev
- Department of HIV/TB, TB Hospital 2, St Petersburg, Russia
| | - V Mitsura
- Gomel State Medical University, Gomel, Belarus
| | - E Borodulina
- Department of Phthisiology and Pulmonology, Samara State Medical University of Minzdrav of Russia, Samara, Russia
| | - A Skrahina
- Republican Research and Practical Clinic for Pulmonology, Minsk, Belarus
| | - E Denisova
- Botkin Hospital of Infectious Disease, St Petersburg, Russia
| | - S Tetradov
- Dr. Victor Babes Hospital, Bucharest, Romania
| | - R Podlasin
- Wojewodski Szpital Zakanzy/Medical University of Warsaw, Warsaw, Poland
| | - V Riekstina
- Clinic of TB and Lung Diseases, Riga, Latvia
| | - Z Kancauskiene
- Clinic for Communicable Diseases and AIDS, Vilnius, Lithuania
| | - D Paduto
- Gomel Region Clinic for Hygiene, Svetlogorsk, Belarus
| | - A Mocroft
- Department of Infection and Population Health, University College London, London, UK
| | - T Trofimova
- Clinic for Prevention and Control of AIDS, Novgorod, Russia
| | - R Miller
- Mortimer Market Clinic, London, UK
| | - F Post
- King's College Hospital, London, UK
| | - A Grezesczuk
- Medical University Teaching Hospital, Bialystok, Poland
| | - J D Lundgren
- CHIP (Centre of Excellence for Health, Immunity and Infections), Department of Infectious Disease, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - M Inglot
- Wroclaw University School of Medicine, Wroclaw, Poland
| | - D Podlekareva
- CHIP (Centre of Excellence for Health, Immunity and Infections), Department of Infectious Disease, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - N Bolokadze
- Infectious Diseases, AIDS and Clinical Immunology Research Clinic, Tbilisi, Georgia
| | - O Kirk
- CHIP (Centre of Excellence for Health, Immunity and Infections), Department of Infectious Disease, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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de Vries G, van de Berg S, van Dam A, Hasanova S, Pareek M, van der Werf MJ, Podlekareva DN. Collaborative tuberculosis/HIV activities in the European Region. ERJ Open Res 2021; 7:00721-2020. [PMID: 33532469 PMCID: PMC7836583 DOI: 10.1183/23120541.00721-2020] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 10/23/2020] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION An estimated 12% of tuberculosis (TB) patients are co-infected with HIV in the World Health Organization European Region (the Region). Reducing morbidity and mortality from HIV-associated TB requires strong collaboration between TB and HIV services at all levels with integrated people-centred models of care. METHODS We collected information on the current models of integration of TB and HIV services in the Region via a comprehensive survey among the TB and HIV National Focal Points, and identified challenges and opportunities. RESULTS 47 out of 55 (85%) countries responded. HIV testing in all TB patients and screening for active TB in all people living with HIV (PLHIV) was recommended in 40 (85%) and 34 (72%) countries, respectively. 30 (64%) countries recommended latent TB infection (LTBI) screening in all PLHIV, while 13 (28%) had a selective approach and four (9%) did not recommend LTBI screening. In most countries, testing for HIV and screening for active TB and LTBI was done by the specialist treating the patient, i.e. TB patients were tested for HIV by a TB specialist in 42 (89%) countries and PLHIV were screened for active TB by an HIV specialist in 34 (72%) countries. CONCLUSIONS TB and HIV care are well integrated in policies of especially high TB and high HIV burden countries; however, implementation needs to be improved. Continuous monitoring of TB and HIV services integration enables assessing the quality of TB/HIV care and to identify where further improvements are needed.
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Affiliation(s)
- Gerard de Vries
- KNCV Tuberculosis Foundation, The Hague, The Netherlands
- National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | | | | | - Sayohat Hasanova
- World Health Organization Regional Office for Europe, Copenhagen, Denmark
| | - Manish Pareek
- Dept of Respiratory Sciences, University of Leicester, Leicester, UK
| | | | - Daria N. Podlekareva
- CHIP, Dept of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- See the Acknowledgements for a list of the Wolfheze Working Group participants
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Qi TK, Chen J, Zhang RF, Liu L, Shen YZ, Wang ZY, Sun JJ, Song W, Tang Y, Wang JR, Ling YX, Xu SB, Yang JY, Lu HZ. A retrospective cohort study of early mortality among patients with HIV/TB co-infection in Shanghai municipality. HIV Med 2020; 21:739-746. [PMID: 33369033 DOI: 10.1111/hiv.13025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/10/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Tuberculosis (TB) is the most common and fatal opportunistic co-infection among HIV-infected individuals. While TB-associated mortality predominantly occurs in the first 90 days after admission, such a correlation remains unclear in HIV/TB co-infected patients. Thus, we aimed to investigate the 90-day mortality and associated risk factors among HIV/TB co-infected patients in China. METHODS Adult patients with HIV and a newly confirmed TB diagnosis admitted to the Shanghai Public Health Clinical Center between September 2009 and August 2017 were enrolled. Clinical and laboratory characteristics, key treatments and outcomes were collected retrospectively. The associations between different factors and early mortality were analysed. RESULTS Of the 485 laboratory-confirmed HIV/TB patients [median (range) age = 39 (19-79) years], 413 (85.15%) were male. Diagnosis was confirmed by culture, pathology and acid-fast bacilli smear alone in 362 (74.6%), 6 (1.2%) and 117 (24.1%) patients, respectively. Multiple drug-/rifampin-resistant TB was detected in 21 (5.8%) of the 367 patients with a positive culture. Rifampin or rifabutin was administered to 402 (82.9%) patients. Additionally, 66 (13.6%) and 86 (17.7%) died within 90 days and 1 year of admission, respectively. Of the 64 TB-related deaths, 59 (92.2%) occurred within 90 days of admission. In Cox regression, central nervous system (CNS) TB [odds ratio (OR) = 2.49, 95% confidence interval (CI): 1.46-4.23, P < 0.001], no antiretroviral therapy (ART) within 3 months after admission (OR = 11, 95% CI: 6.4-18.9, P < 0.001), and plasma albumin level < 25 g/L (OR = 1.91, 95% CI: 1.07-3.40, P = 0.021) were associated with early death. CONCLUSIONS Tuberculosis co-infection was prevalent and fatal in HIV-infected patients, with most deaths occurring within 90 days of admission. Early mortality was associated with CNS-TB, no ART, and serum albumin level < 25 g/L.
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Affiliation(s)
- T K Qi
- Department of Infectious Diseases and Immunology, Shanghai Public Health Clinical Center, Shanghai, China
| | - J Chen
- Department of Infectious Diseases and Immunology, Shanghai Public Health Clinical Center, Shanghai, China
| | - R F Zhang
- Department of Infectious Diseases and Immunology, Shanghai Public Health Clinical Center, Shanghai, China
| | - L Liu
- Department of Infectious Diseases and Immunology, Shanghai Public Health Clinical Center, Shanghai, China
| | - Y Z Shen
- Department of Infectious Diseases and Immunology, Shanghai Public Health Clinical Center, Shanghai, China
| | - Z Y Wang
- Department of Infectious Diseases and Immunology, Shanghai Public Health Clinical Center, Shanghai, China
| | - J J Sun
- Department of Infectious Diseases and Immunology, Shanghai Public Health Clinical Center, Shanghai, China
| | - W Song
- Department of Infectious Diseases and Immunology, Shanghai Public Health Clinical Center, Shanghai, China
| | - Y Tang
- Department of Infectious Diseases and Immunology, Shanghai Public Health Clinical Center, Shanghai, China
| | - J R Wang
- Department of Infectious Diseases and Immunology, Shanghai Public Health Clinical Center, Shanghai, China
| | - Y X Ling
- Department of Infectious Diseases and Immunology, Shanghai Public Health Clinical Center, Shanghai, China
| | - S B Xu
- Department of Infectious Diseases and Immunology, Shanghai Public Health Clinical Center, Shanghai, China
| | - J Y Yang
- Department of Infectious Diseases and Immunology, Shanghai Public Health Clinical Center, Shanghai, China
| | - H Z Lu
- Department of Infectious Diseases and Immunology, Shanghai Public Health Clinical Center, Shanghai, China
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Upadhana PS, Iqra HHP, Cahyarini IGAAC, Somia IKA, Anandasari PPY. Correlation Between Clinical Manifestation and Radiological Findings In Pulmonary Tuberculosis-Human Immunodeficiency Virus Coinfection Patients In Sanglah Hospital, Bali, Indonesia. Curr HIV Res 2020; 18:426-435. [PMID: 32753018 DOI: 10.2174/1570162x18666200804152126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 06/29/2020] [Accepted: 07/17/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Tuberculosis (TB) mono-infection has radiological features and typical clinical manifestations that are easily recognized by clinicians. These radiological features and clinical manifestations are often found to show atypical features in subjects coinfected with Tuberculosis- Human Immunodeficiency Virus (HIV), making TB diagnosis and early management challenging to establish. OBJECTIVE The aim of this study was to determine the relationship between the clinical and radiological presentation of pulmonary TB patients with HIV coinfection at the Central General Hospital Sanglah, Bali. METHODS This research was an observational analytic study with a cross-sectional method. A total of 54 TB-HIV coinfected patients were analyzed to their sociodemographic characteristics, clinical manifestations and chest radiographic features. RESULTS The majority of subjects were of productive age (26-61 years), male (64.8%) and belonged to the heterosexual group (90.7%). Weight loss (75.9%), cough (64.8%) and oral candidiasis (53.7%) are the most common clinical manifestations found in subjects, especially in subjects with CD4+ >200 cells/mm3. Atypical radiological features such as infiltration/consolidation (59.3%), fibrosis (16.7%) and hillar lymphadenopathy (14.8%) are the most commonly obtained radiological features of the subjects. From the results of the bivariate analysis, it was found that radiological features in the form of infiltration/consolidation were more commonly found in subjects with CD4+ <200 cells/mm3 (OR=1.254; 95% CI 1.059-1.568). CONCLUSION Based on the research that has been done, it can be concluded that there are no typical radiological features and clinical manifestations in patients with TB-HIV infection.
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Affiliation(s)
- Putu Satyakumara Upadhana
- Bachelor of Medicine and Medical Education Study Program, Medical Faculty, Udayana University, Denpasar, Indonesia
| | - Haikal Hamas Putra Iqra
- Bachelor of Medicine and Medical Education Study Program, Medical Faculty, Udayana University, Denpasar, Indonesia
| | | | - I Ketut Agus Somia
- Division of Tropical and Infectious Disease, Department of Internal Medicine, Medical Faculty, Udayana University, Denpasar, Indonesia
| | - Pande Putu Yuli Anandasari
- Division of Pediatric Radiology, Department of Radiology, Medical Faculty, Udayana University, Denpasar, Indonesia
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Holmberg V, Soini H, Kivelä P, Ollgren J, Ristola M. Epidemiology and outcome of HIV patients in Finland co-infected with tuberculosis 1998-2015. BMC Infect Dis 2019; 19:264. [PMID: 30885144 PMCID: PMC6423794 DOI: 10.1186/s12879-019-3890-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Accepted: 03/07/2019] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Tuberculosis (TB) is a major cause of death in HIV patients worldwide. Here we describe the epidemiology and outcome of HIV-TB co-infections in a high-income country with low TB incidence and integrated HIV and TB therapy according to European guidelines. METHODS This study was based on the HIV cohort of the Helsinki University Hospital which includes all HIV patients in the Helsinki region with a population of 1.5 million. Totally, 1939 HIV-positives who have been under follow-up between 1998 and 2015 were included. RESULTS TB was diagnosed in 53 (2.7%) of the HIV-patients. The TB incidence rate was higher in injecting drug users (IRR 3.15; 95% CI 1.33-7.52) and heterosexuals (IRR 3.46; 95% CI 1.64-7.29) compared to men having sex with men. The incidence rate was also higher in those born in Sub-Saharan Africa (IRR 3.53; 95% CI 1.78-7.03) compared to those born in Finland. There was a significant reduction in the total TB incidence rate of 59% per 6-year period between 1998 and 2015 (p < 0.001). In injecting drug users there was a reduction in incidence rate from 1182 to 88 per 100,000 (p < 0.001) and in people born in Sub-Saharan Africa from 2017 to 195 per 100,000 (p < 0.001). Among the 53 HIV-TB co-infected cases, one female and 15 males died during follow up. HIV was the primary cause of death in five patients but none of the deaths were caused by TB. CONCLUSION The incidence rate of tuberculosis among HIV-positives in Finland has been declining between 1998 and 2015. Among injecting drug users, the reduction is probably explained by harm reduction interventions and care in comprehensive care centers in Helsinki. The increased coverage of antiretroviral therapy is probably another main reason for the decline in TB incidence rates. Despite good treatment results for both HIV and TB, the all-cause mortality among Finnish males with HIV-TB was high, and common causes of death were intoxications and suicides.
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Affiliation(s)
- Ville Holmberg
- Clinic of Infectious Diseases, Inflammation Center, Helsinki University Hospital, Post Box 348, 00029 HUS, Helsinki, Finland.
- Department of Internal Medicine, Clinicum, Medical Faculty, University of Helsinki, Helsinki, Finland.
| | - Hanna Soini
- Department of Health Security, National Institute of Health and Welfare, Helsinki, Finland
| | - Pia Kivelä
- Clinic of Infectious Diseases, Inflammation Center, Helsinki University Hospital, Post Box 348, 00029 HUS, Helsinki, Finland
| | - Jukka Ollgren
- Department of Health Security, National Institute of Health and Welfare, Helsinki, Finland
| | - Matti Ristola
- Department of Internal Medicine, Clinicum, Medical Faculty, University of Helsinki, Helsinki, Finland
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Nguyen DT, Graviss EA. Development and validation of a risk score to predict mortality during TB treatment in patients with TB-diabetes comorbidity. BMC Infect Dis 2019; 19:10. [PMID: 30611208 PMCID: PMC6321653 DOI: 10.1186/s12879-018-3632-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 12/18/2018] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Making an accurate prognosis for mortality during tuberculosis (TB) treatment in TB-diabetes (TB-DM) comorbid patients remains a challenge for health professionals, especially in low TB prevalent populations, due to the lack of a standardized prognostic model. METHODS Using de-identified data from TB-DM patients from Texas, who received TB treatment had a treatment outcome of completed treatment or died before completion, reported to the National TB Surveillance System from January 2010-December 2016, we developed and internally validated a mortality scoring system, based on the regression coefficients. RESULTS Of 1227 included TB-DM patients, 112 (9.1%) died during treatment. The score used nine characteristics routinely collected by most TB programs. Patients were divided into three groups based on their score: low-risk (< 12 points), medium-risk (12-21 points) and high-risk (≥22 points). The model had good performance (with an area under the receiver operating characteristic (ROC) curve of 0.83 in development and 0.82 in validation), and good calibration. A practical mobile calculator app was also created ( https://oaa.app.link/Isqia5rN6K ). CONCLUSION Using demographic and clinical characteristics which are available from most TB programs at the patient's initial visits, our simple scoring system had good performance and may be a practical clinical tool for TB health professionals in identifying TB-DM comorbid patients with a high mortality risk.
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Affiliation(s)
- Duc T. Nguyen
- Department of Pathology and Genomic Medicine, Houston Methodist Research Institute, Mail Station: R6-414, 6670 Bertner Ave, Houston, TX 77030 USA
| | - Edward A. Graviss
- Department of Pathology and Genomic Medicine, Houston Methodist Research Institute, Mail Station: R6-414, 6670 Bertner Ave, Houston, TX 77030 USA
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Nguyen DT, Jenkins HE, Graviss EA. Prognostic score to predict mortality during TB treatment in TB/HIV co-infected patients. PLoS One 2018; 13:e0196022. [PMID: 29659636 PMCID: PMC5901929 DOI: 10.1371/journal.pone.0196022] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 04/04/2018] [Indexed: 11/19/2022] Open
Abstract
Background Estimating mortality risk during TB treatment in HIV co-infected patients is challenging for health professionals, especially in a low TB prevalence population, due to the lack of a standardized prognostic system. The current study aimed to develop and validate a simple mortality prognostic scoring system for TB/HIV co-infected patients. Methods Using data from the CDC’s Tuberculosis Genotyping Information Management System of TB patients in Texas reported from 01/2010 through 12/2016, age ≥15 years, HIV(+), and outcome being “completed” or “died”, we developed and internally validated a mortality prognostic score using multiple logistic regression. Model discrimination was determined by the area under the receiver operating characteristic (ROC) curve (AUC). The model’s good calibration was determined by a non-significant Hosmer-Lemeshow’s goodness of fit test. Results Among the 450 patients included in the analysis, 57 (12.7%) died during TB treatment. The final prognostic score used six characteristics (age, residence in long-term care facility, meningeal TB, chest x-ray, culture positive, and culture not converted/unknown), which are routinely collected by TB programs. Prognostic scores were categorized into three groups that predicted mortality: low-risk (<20 points), medium-risk (20–25 points) and high-risk (>25 points). The model had good discrimination and calibration (AUC = 0.82; 0.80 in bootstrap validation), and a non-significant Hosmer-Lemeshow test p = 0.71. Conclusion Our simple validated mortality prognostic scoring system can be a practical tool for health professionals in identifying TB/HIV co-infected patients with high mortality risk.
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Affiliation(s)
- Duc T. Nguyen
- Houston Methodist Hospital Institute, Houston, Texas, United States of America
| | - Helen E. Jenkins
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts, United States of America
| | - Edward A. Graviss
- Houston Methodist Hospital Institute, Houston, Texas, United States of America
- * E-mail:
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11
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Nguyen DT, Graviss EA. Development and validation of a prognostic score to predict tuberculosis mortality. J Infect 2018; 77:283-290. [PMID: 29649520 DOI: 10.1016/j.jinf.2018.02.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Revised: 02/18/2018] [Accepted: 02/19/2018] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To develop and validate a simple prognostic scoring system to predict the mortality risk during treatment in tuberculosis patients. METHODS Using data from the CDC's Tuberculosis Genotyping Information Management System of TB patients in Texas reported from 01/2010 to 12/2016, age ≥ 15 years and having an outcome as "completed" or "died", we developed and validated a prognostic mortality scoring system-based logistic regression beta-coefficients. RESULTS The developmental and validation cohorts consisted of 3378 and 3377 patients, respectively. The score used 9 demographic and clinical characteristics, which are usually available at the patient's initial visits to a healthcare facility. Prognostic scores were categorized into three groups that predicted mortality: low-risk (<15 points), medium-risk (15-18 points), and high-risk (>18 points). The model had excellent discrimination and calibration with an area under the receiver operating characteristic curve of 0.82 and 0.80, and a non-significant Hosmer-Lemeshow test P = 0.514 and P = 0.613 in the developmental and validation cohorts, respectively. CONCLUSION Our validated TB prognostic scoring system, which used demographic and clinical characteristics available at the patient's initial visits, can be a practical tool for health care providers to identify TB patients with high mortality risk so that appropriate treatment, medical supports and follow-up resources could be appropriately allocated.
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Affiliation(s)
- Duc T Nguyen
- Houston Methodist Research Institute, 6670 Bertner Ave, Houston, TX 77030, USA
| | - Edward A Graviss
- Houston Methodist Research Institute, 6670 Bertner Ave, Houston, TX 77030, USA.
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12
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Muyaya LM, Young T, Loveday M. Predictors of mortality in adults on treatment for human immunodeficiency virus-associated tuberculosis in Botswana: A retrospective cohort study. Medicine (Baltimore) 2018; 97:e0486. [PMID: 29668628 PMCID: PMC5916691 DOI: 10.1097/md.0000000000010486] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Mortality in patients with human immunodeficiency virus (HIV)-associated tuberculosis (TB) is high, particularly in sub-Saharan Africa. This study aimed to compare mortality and predictors of mortality in those who were antiretroviral therapy (ART) naïve to those with prior ART exposure.This retrospective cohort study was conducted in Serowe/Palapye District, Botswana, a predominantly urban district with a large burden of HIV-associated TB with a high case fatality. Between January 1, 2013 and December 31, 2013, patients confirmed with HIV-associated TB were enrolled and followed up. Kaplan-Meier and Cox proportional hazard modeling was undertaken to identify predictors of mortality, with ART initiation included as time-updated variable.Among the 300 patients enrolled in the study, 131 had started ART before TB diagnosis (44%). There were 45 deaths. There was no difference in mortality between ART-naïve patients and those with prior ART exposure. In the multivariate analysis, no ART use during TB treatment (hazard ratio [HR] = 5.6, 95% confidence interval [CI] = 2.9-11; P < .001), opportunistic infections other than TB (HR = 8.5, 95% CI = 4-18.4; P = .013), age ≥60 years (HR = 4.8, 95% CI = 1.8-13; P = .002), hemoglobin <10 g/dL (HR = 2.4, 95% CI = 1.3-4.5) and hepatotoxicity (HR = 5, 95% CI = 1.6-17; P = .007) were associated with increased mortality. In the subgroup analysis, among ART-naïve patients, no ART use during TB treatment (HR = 8.1, 95% CI = 3.4-19.4; P < .001), opportunistic infections other than TB (HR = 16, 95% CI = 6.2-42; P < .001), and hepatotoxicity (HR = 8.3, 95% CI = 2.6-27; P < .001) were associated with mortality. Among patients with prior ART exposure, opportunistic infections other than TB (HR = 6, 95% CI = 2.6-27; P < .001) were associated with mortality.Mortality in patients with HIV-associated TB is still high. To reduce mortality, close clinical monitoring of patients together with initiation of ART during TB treatment is indicated.
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Affiliation(s)
- Ley Muyaya Muyaya
- Division of Epidemiology and Biostatistics, Faculty of Medicine and Health Sciences, Stellenbosch University
- Palapye District Health Management Team, Ministry of Health, Palapye, Botswana
| | - Taryn Young
- Division of Epidemiology and Biostatistics, Faculty of Medicine and Health Sciences, Stellenbosch University
- Centre for Evidence-based Health Care, Faculty of Medicine and Health Sciences, Stellenbosch University
| | - Marian Loveday
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
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13
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Efsen AMW, Schultze A, Miller RF, Panteleev A, Skrahin A, Podlekareva DN, Miro JM, Girardi E, Furrer H, Losso MH, Toibaro J, Caylà JA, Mocroft A, Lundgren JD, Post FA, Kirk O. Management of MDR-TB in HIV co-infected patients in Eastern Europe: Results from the TB:HIV study. J Infect 2018; 76:44-54. [PMID: 29061336 PMCID: PMC6293190 DOI: 10.1016/j.jinf.2017.10.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2017] [Revised: 10/02/2017] [Accepted: 10/07/2017] [Indexed: 01/21/2023]
Abstract
OBJECTIVES Mortality among HIV patients with tuberculosis (TB) remains high in Eastern Europe (EE), but details of TB and HIV management remain scarce. METHODS In this prospective study, we describe the TB treatment regimens of patients with multi-drug resistant (MDR) TB and use of antiretroviral therapy (ART). RESULTS A total of 105 HIV-positive patients had MDR-TB (including 33 with extensive drug resistance) and 130 pan-susceptible TB. Adequate initial TB treatment was provided for 8% of patients with MDR-TB compared with 80% of those with pan-susceptible TB. By twelve months, an estimated 57.3% (95%CI 41.5-74.1) of MDR-TB patients had started adequate treatment. While 67% received ART, HIV-RNA suppression was demonstrated in only 23%. CONCLUSIONS Our results show that internationally recommended MDR-TB treatment regimens were infrequently used and that ART use and viral suppression was well below the target of 90%, reflecting the challenging patient population and the environment in which health care is provided. Urgent improvement of management of patients with TB/HIV in EE, in particular for those with MDR-TB, is needed and includes widespread access to rapid TB diagnostics, better access to and use of second-line TB drugs, timely ART initiation with viral load monitoring, and integration of TB/HIV care.
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Affiliation(s)
- A M W Efsen
- CHIP, Department of Infectious Diseases, Finsencentret, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, Copenhagen 2100, Denmark.
| | - A Schultze
- Department of Infection and Population Health, University College London Medical School, Rowland Hill Street, London NW3 2PF, UK
| | - R F Miller
- Centre for Sexual Health and HIV Research, Mortimer Market Centre, University College London, London WC1E 6JB, UK
| | - A Panteleev
- Department of HIV/TB, TB hospital 2, Ushinskogo str 39/1 - 122, St. Petersburg 195267, Russia
| | - A Skrahin
- Clinical Department, Republican Research and Practical Centre for Pulmonology and TB, Minsk, Belarus
| | - D N Podlekareva
- CHIP, Department of Infectious Diseases, Finsencentret, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, Copenhagen 2100, Denmark
| | - J M Miro
- Infectious Diseases Service, Hospital Clinic - IDIBAPS, University of Barcelona, Villarroel, 170, Barcelona 08036, Spain
| | - E Girardi
- Department of Infectious Diseases INMI "L. Spallanzani", Ospedale L Spallanzani, Via Portuense, 292, Rome 00149, Italy
| | - H Furrer
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern CH-3010, Switzerland
| | - M H Losso
- Department of immunocompromised, Hospital J.M. Ramos Mejia, Pabellón de Cliníca, 2do Piso, Buenos Aires CP 1221, Argentina
| | - J Toibaro
- Department of immunocompromised, Hospital J.M. Ramos Mejia, Pabellón de Cliníca, 2do Piso, Buenos Aires CP 1221, Argentina
| | - J A Caylà
- Agencia de Salud Pública de Barcelona, Barcelona, Spain; Programa Integrado de Investigación en Tuberculosis de SEPAR (PII-TB), Barcelona, Spain; Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - A Mocroft
- Department of Infection and Population Health, University College London Medical School, Rowland Hill Street, London NW3 2PF, UK
| | - J D Lundgren
- CHIP, Department of Infectious Diseases, Finsencentret, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, Copenhagen 2100, Denmark
| | - F A Post
- Department of Sexual Health, Caldecot Centre, King's College Hospital, Bessemer Road, London SE5 9RS, UK
| | - O Kirk
- CHIP, Department of Infectious Diseases, Finsencentret, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, Copenhagen 2100, Denmark
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Tavares AM, Fronteira I, Couto I, Machado D, Viveiros M, Abecasis AB, Dias S. HIV and tuberculosis co-infection among migrants in Europe: A systematic review on the prevalence, incidence and mortality. PLoS One 2017; 12:e0185526. [PMID: 28957400 PMCID: PMC5619775 DOI: 10.1371/journal.pone.0185526] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Accepted: 09/14/2017] [Indexed: 12/20/2022] Open
Abstract
Background International human migration has been rapidly growing. Migrants coming from low and middle income countries continue to be considerably vulnerable and at higher risk for infectious diseases, namely HIV (Human Immunodeficiency Virus) and tuberculosis (TB). In Europe, the number of patients with HIV-TB co-infection has been increasing and migration could be one of the potential driving forces. Objective This systematic review aims to improve the understanding on the burden of HIV-TB co-infection among migrants in Europe and to assess whether these populations are particularly vulnerable to this co-infection compared to nationals. Design MEDLINE®, Web of Science® and Scopus® databases were searched from March to April 2016 using combinations of keywords. Titles and abstracts were screened and studies meeting the inclusion criteria proceeded for full-text revision. These articles were then selected for data extraction on the prevalence, incidence and mortality. Results The majority of HIV-TB prevalence data reported in the analysed studies, including extrapulmonary/disseminated TB forms, was higher among migrant vs. nationals, some of the studies even showing increasing trends over time. Additionally, while HIV-TB incidence rates have decreased among migrants and nationals, migrants are still at a higher risk for this co-infection. Migrants with HIV-TB co-infection were also more prone to unsuccessful treatment outcomes, death and drug resistant TB. However, contradicting results also showed lower mortality compared to nationals. Conclusions Overall, a disproportionate vulnerability of migrants to acquire the HIV-TB co-infection was observed across studies. Such vulnerability has been associated to low socioeconomic status, poor living conditions and limited access to healthcare. Adequate social support, early detection, appropriate treatment, and adequate access to healthcare are key improvements to tackle HIV-TB co-infection among these populations.
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Affiliation(s)
- Ana Maria Tavares
- Global Health and Tropical Medicine, GHTM, Instituto de Higiene e Medicina Tropical, IHMT, Universidade Nova de Lisboa, UNL, Lisboa, Portugal
- * E-mail: (SD); (AMT)
| | - Inês Fronteira
- Global Health and Tropical Medicine, GHTM, Instituto de Higiene e Medicina Tropical, IHMT, Universidade Nova de Lisboa, UNL, Lisboa, Portugal
| | - Isabel Couto
- Global Health and Tropical Medicine, GHTM, Instituto de Higiene e Medicina Tropical, IHMT, Universidade Nova de Lisboa, UNL, Lisboa, Portugal
| | - Diana Machado
- Global Health and Tropical Medicine, GHTM, Instituto de Higiene e Medicina Tropical, IHMT, Universidade Nova de Lisboa, UNL, Lisboa, Portugal
| | - Miguel Viveiros
- Global Health and Tropical Medicine, GHTM, Instituto de Higiene e Medicina Tropical, IHMT, Universidade Nova de Lisboa, UNL, Lisboa, Portugal
| | - Ana B. Abecasis
- Global Health and Tropical Medicine, GHTM, Instituto de Higiene e Medicina Tropical, IHMT, Universidade Nova de Lisboa, UNL, Lisboa, Portugal
| | - Sónia Dias
- Global Health and Tropical Medicine, GHTM, Instituto de Higiene e Medicina Tropical, IHMT, Universidade Nova de Lisboa, UNL, Lisboa, Portugal
- * E-mail: (SD); (AMT)
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Pefura-Yone EW, Balkissou AD, Poka-Mayap V, Fatime-Abaicho HK, Enono-Edende PT, Kengne AP. Development and validation of a prognostic score during tuberculosis treatment. BMC Infect Dis 2017; 17:251. [PMID: 28388895 PMCID: PMC5385091 DOI: 10.1186/s12879-017-2309-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2015] [Accepted: 03/08/2017] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Death under care is a major challenge for tuberculosis (TB) treatment programs. We derived and validated a simple score to predict mortality during tuberculosis treatment in high endemicity areas. METHODS We used data for patients aged ≥15 years, diagnosed and treated for tuberculosis at the Yaounde Jamot Hospital between January 2012 and December 2013. Baseline characteristics associated with mortality were investigated using logistic regressions. A simple prognosis score (CABI) was constructed with regression coefficients for predictors in the final model. Internal validation used bootstrap resampling procedures. Models discrimination was assessed using c-statistics and calibration assessed via calibration plots and the Hosmer and Lemeshwow (H-L) statistics. The optimal score was based on the Youden's index. RESULTS A total of 2250 patients (men 57.2%) with a mean age of 35.8 years were included; among whom 213 deaths (cumulative incidence 9.5%) were recorded. Clinical form of tuberculosis (C), age (A, years), adjusted body mass index (B, BMI, kg/m2) and status for HIV (Human immunodefiency virus) infection (I) were significant predictors in the final model (p < 0.0001) which was of the form Death risk = 1/(1 + e - (-1.3120 + 0.0474 ∗ age - 0.1866 ∗ BMI + 1.1637 (if smear negative TB) + 0.5418(if extra - pulmonary TB) + 1.3820(if HIV+))). The c-statistic was 0.812 in the derivation sample and 0.808 after correction for optimism. The calibration was good [H-Lχ2 = 6.44 (p = 0.60)]. The optimal absolute risk threshold was 4.8%, corresponding to a sensitivity of 81% and specificity of 67%. CONCLUSIONS The preliminary promising findings from this study require confirmation through independent external validation studies. If confirmed, the model derived could facilitate the stratification of TB patients for mortality risk and implementation of additional monitoring and management measures in vulnerable patients.
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Affiliation(s)
- Eric Walter Pefura-Yone
- Department of Internal medicine and specialities, Faculty of Medicine and Biomedical Sciences, University of Yaounde 1, Yaounde, Cameroon. .,Yaounde Jamot Hospital, P.O Box: 4021, Yaounde, Cameroon.
| | - Adamou Dodo Balkissou
- Department of Internal medicine and specialities, Faculty of Medicine and Biomedical Sciences, University of Yaounde 1, Yaounde, Cameroon.,Yaounde Jamot Hospital, P.O Box: 4021, Yaounde, Cameroon
| | - Virginie Poka-Mayap
- Department of Internal medicine and specialities, Faculty of Medicine and Biomedical Sciences, University of Yaounde 1, Yaounde, Cameroon
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16
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Podlekareva DN, Efsen AMW, Schultze A, Post FA, Skrahina AM, Panteleev A, Furrer H, Miller RF, Losso MH, Toibaro J, Miro JM, Vassilenko A, Girardi E, Bruyand M, Obel N, Lundgren JD, Mocroft A, Kirk O. Tuberculosis-related mortality in people living with HIV in Europe and Latin America: an international cohort study. Lancet HIV 2016; 3:e120-e131. [PMID: 26939735 DOI: 10.1016/s2352-3018(15)00252-0] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Revised: 12/11/2015] [Accepted: 12/14/2015] [Indexed: 06/05/2023]
Abstract
BACKGROUND Management of tuberculosis in patients with HIV in eastern Europe is complicated by the high prevalence of multidrug-resistant tuberculosis, low rates of drug susceptibility testing, and poor access to antiretroviral therapy (ART). We report 1 year mortality estimates from a multiregional (eastern Europe, western Europe, and Latin America) prospective cohort study: the TB:HIV study. METHODS Consecutive HIV-positive patients aged 16 years or older with a diagnosis of tuberculosis between Jan 1, 2011, and Dec 31, 2013, were enrolled from 62 HIV and tuberculosis clinics in 19 countries in eastern Europe, western Europe, and Latin America. The primary endpoint was death within 12 months after starting tuberculosis treatment; all deaths were classified according to whether or not they were tuberculosis related. Follow-up was either until death, the final visit, or 12 months after baseline, whichever occurred first. Risk factors for all-cause and tuberculosis-related deaths were assessed using Kaplan-Meier estimates and Cox models. FINDINGS Of 1406 patients (834 in eastern Europe, 317 in western Europe, and 255 in Latin America), 264 (19%) died within 12 months. 188 (71%) of these deaths were tuberculosis related. The probability of all-cause death was 29% (95% CI 26-32) in eastern Europe, 4% (3-7) in western Europe, and 11% (8-16) in Latin America (p<0·0001) and the corresponding probabilities of tuberculosis-related death were 23% (20-26), 1% (0-3), and 4% (2-8), respectively (p<0·0001). Patients receiving care outside eastern Europe had a 77% decreased risk of death: adjusted hazard ratio (aHR) 0·23 (95% CI 0·16-0·31). In eastern Europe, compared with patients who started a regimen with at least three active antituberculosis drugs, those who started fewer than three active antituberculosis drugs were at a higher risk of tuberculosis-related death (aHR 3·17; 95% CI 1·83-5·49) as were those who did not have baseline drug-susceptibility tests (2·24; 1·31-3·83). Other prognostic factors for increased tuberculosis-related mortality were disseminated tuberculosis and a low CD4 cell count. 18% of patients were receiving ART at tuberculosis diagnosis in eastern Europe compared with 44% in western Europe and 39% in Latin America (p<0·0001); 12 months later the proportions were 67% in eastern Europe, 92% in western Europe, and 85% in Latin America (p<0·0001). INTERPRETATION Patients with HIV and tuberculosis in eastern Europe have a risk of death nearly four-times higher than that in patients from western Europe and Latin America. This increased mortality rate is associated with modifiable risk factors such as lack of drug susceptibility testing and suboptimal initial antituberculosis treatment in settings with a high prevalence of drug resistance. Urgent action is needed to improve tuberculosis care for patients living with HIV in eastern Europe. FUNDING EU Seventh Framework Programme.
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Affiliation(s)
- Daria N Podlekareva
- CHIP, Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
| | - Anne Marie W Efsen
- CHIP, Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Anna Schultze
- Department of Infection and Population Health, University College London Medical School, London, UK
| | - Frank A Post
- Department of Sexual Health, King's College Hospital, London, UK
| | - Alena M Skrahina
- Republican Research and Practical Centre for Pulmonology and TB, Minsk, Belarus
| | | | - Hansjakob Furrer
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Robert F Miller
- Centre for Sexual Health and HIV Research, University College London, London, UK
| | - Marcelo H Losso
- Department of Immunocompromised, Hospital J M Ramos Mejia, Buenos Aires, Argentina
| | - Javier Toibaro
- Department of Immunocompromised, Hospital J M Ramos Mejia, Buenos Aires, Argentina
| | - Jose M Miro
- Infectious Diseases Service, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Anna Vassilenko
- Belarusian State Medical University, Minsk, Belarus; Department of Infectious Diseases, City Clinical Hospital of infectious Diseases, Minsk, Belarus
| | - Enrico Girardi
- Department of Infectious Diseases INMI "L. Spallanzani", Ospedale L Spallanzani, Rome, Italy
| | - Mathias Bruyand
- INSERM, ISPED, Centre Inserm U897-Epidemiologie-Biostatistique, Bordeaux, France
| | - Niels Obel
- Department of Infectious Diseases, Finsencentret, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Jens D Lundgren
- CHIP, Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Amanda Mocroft
- Department of Infection and Population Health, University College London Medical School, London, UK
| | - Ole Kirk
- CHIP, Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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Zenner D, Abubakar I, Conti S, Gupta RK, Yin Z, Kall M, Kruijshaar M, Rice B, Thomas HL, Pozniak A, Lipman M, Delpech V. Impact of TB on the survival of people living with HIV infection in England, Wales and Northern Ireland. Thorax 2015; 70:566-73. [PMID: 25805209 DOI: 10.1136/thoraxjnl-2014-206452] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2014] [Accepted: 02/18/2015] [Indexed: 11/04/2022]
Abstract
INTRODUCTION The impact of TB disease on survival in people living with HIV in high resource settings is not well documented in the antiretroviral treatment (ART) era. We calculated TB incidence rates and compared the mortality of persons with and without HIV-TB in a UK HIV cohort in the post-ART era, to determine the impact of HIV-TB on survival in the UK. METHODS We linked the national cohort of persons (aged ≥15 years) diagnosed with HIV between 2000 and 2008 in England, Wales and Northern Ireland with the national TB register and deaths from the Office of National Statistics. We compared all-cause and AIDS-specific mortality in patients with and without TB by estimating HRs using Cox regression modelling allowing for potential predictors. RESULTS Overall, 3188 (7.2%) individuals developed TB infection among a cohort of 44 050 HIV-diagnosed persons and 149 663 person-years. The cumulative TB incidence rate was 2.13 per 100 person-years with a spike within the first 6 months after HIV diagnosis. TB coinfected patients comprised 18% of the 1880 deaths during follow-up and 79% of deaths (n=967) in the year following HIV diagnosis. TB coinfection (HR 4.77, 95% CI 4.11 to 5.54) was significantly associated with increased all-cause mortality. Analysis of AIDS-related survival showed similar results. DISCUSSION The unexpected high mortality in patients with HIV-TB in a population with good healthcare access and ART availability highlights the importance of improving active and latent TB case-finding among patients with HIV, and HIV-testing among patients with TB, to ensure appropriate and prompt treatment initiation for both diseases.
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Affiliation(s)
- Dominik Zenner
- Respiratory Diseases Department, Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK Research Department of Infection and Population Health, University College London, London, UK
| | - Ibrahim Abubakar
- Respiratory Diseases Department, Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK Research Department of Infection and Population Health, University College London, London, UK
| | - Stefano Conti
- Respiratory Diseases Department, Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK
| | - Rishi K Gupta
- Division of Medicine, University College London, London, UK
| | - Zheng Yin
- Respiratory Diseases Department, Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK
| | - Meaghan Kall
- Respiratory Diseases Department, Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK
| | - Michelle Kruijshaar
- Erasmus MC University Medical Center, Sophia Children's Hospital, Rotterdam, Netherlands
| | - Brian Rice
- Respiratory Diseases Department, Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK
| | - H Lucy Thomas
- Respiratory Diseases Department, Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK
| | - Anton Pozniak
- Chelsea & Westminster Hospitals NHS Foundation Trust, London, UK
| | - Marc Lipman
- Division of Medicine, University College London, London, UK
| | - Valerie Delpech
- Respiratory Diseases Department, Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK
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van den Hof S, Tursynbayeva A, Abildaev T, Adenov M, Pak S, Ismailov S. HIV and multidrug-resistant tuberculosis: overlapping risk factors. Eur Respir J 2015; 45:567-9. [DOI: 10.1183/09031936.00131014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Ordonez AA, Maiga M, Gupta S, Weinstein EA, Bishai WR, Jain SK. Novel adjunctive therapies for the treatment of tuberculosis. Curr Mol Med 2014; 14:385-95. [PMID: 24236454 DOI: 10.2174/1566524013666131118112431] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Revised: 07/07/2013] [Accepted: 08/05/2013] [Indexed: 11/22/2022]
Abstract
Despite significant efforts to control tuberculosis (TB), the disease remains a major global threat, with an estimated 8.6 million new cases and 1.3 million deaths in 2012 alone. Significant treatment challenges include HIV co-infection, the dramatic rise of multidrug-resistant TB and the vast reservoir of latently infected individuals, who will develop active disease years after the initial infection. The long duration of chemotherapy also remains a major barrier to effective large scale treatment of TB. Significant advances are being made in the development of shorter and effective TB drug regimens and there is growing evidence that host-directed and "non-antimicrobial" pathogen-directed therapies, could serve as novel approaches to enhance TB treatments. This review highlights the rationale for using these therapies and summarizes some of the progress in this field.
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Affiliation(s)
| | | | | | | | | | - S K Jain
- Center for Infection and Inflammation Imaging Research, 1550 Orleans Street, Rm 1.09, Baltimore, MD 21287, USA.
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García-Basteiro AL, López-Varela E, Respeito D, González R, Naniche D, Manhiça I, Macete E, Cobelens F, Alonso PL. High tuberculosis burden among people living with HIV in southern Mozambique. Eur Respir J 2014; 45:547-9. [PMID: 25395030 DOI: 10.1183/09031936.00145714] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Alberto L García-Basteiro
- Manhiça Health Research Center (CISM), Maputo, Mozambique ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - Elisa López-Varela
- Manhiça Health Research Center (CISM), Maputo, Mozambique ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | | | - Raquel González
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - Denise Naniche
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - Ivan Manhiça
- Ministry of Health, National Tuberculosis Program, Maputo, Mozambique
| | - Eusebio Macete
- Manhiça Health Research Center (CISM), Maputo, Mozambique
| | - Frank Cobelens
- Amsterdam Institute for Global Health and Development, Academic Medical Centre, Amsterdam, The Netherlands
| | - Pedro L Alonso
- Manhiça Health Research Center (CISM), Maputo, Mozambique ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
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Wen Y, Zhou Y, Wang W, Wang Y, Lu X, Sun CM, Cui W, Liu J, Geng WQ, Shang H, Liu P. Baseline factors associated with mortality within six months after admission among hospitalized HIV-1 patients in Shenyang, China. Intern Med 2014; 53:2455-61. [PMID: 25366003 DOI: 10.2169/internalmedicine.53.2502] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE Short-term mortality rates remain high among critically ill human immunodeficiency virus-1 (HIV-1) patients though long-term mortality rates have dropped. Baseline risk factors for short-term mortality have not yet been determined in China. In this paper, we herein describe clinical characteristics, laboratory findings, causes of clinical deterioration, and risk factors associated with mortality among HIV-1 patients within six months after hospital admission. METHODS We carried out a prospective study of hospitalized patients in advanced stages of HIV infection. These patients started antiretroviral therapy three or four weeks after admission. Follow-up was conducted for a period of six months. We used a multivariate logistic-regression analysis to identify risk factors associated with mortality. RESULTS A total of 141 patients met our inclusion criteria. The mean age was 41 years. Fever and weight loss were the most common clinical manifestations of advanced HIV disease. Oral candidiasis, tuberculosis, cytomegaloviremia, and pneumocystis pneumonia were the most common opportunistic infections. Significantly decreased CD4+ T-cell counts, hypoalbuminemia, anemia, hyponatremia, as well as elevated C-reactive protein (CRP) and glutamic alanine transaminase levels were common laboratory test abnormalities. The mortality rate was 21.3%. The patients who died were more likely than the survivors to have low CD4+ T-cell counts as well as low creatinine, hemoglobin, albumin, and serum sodium levels while also having longer intervals of fever and higher CRP levels. A multivariate analysis demonstrated that the independent risk factors for mortality were active tuberculosis [odds ratio (OR): 2.681; 95% confidence interval (CI), 1.006-7.142; p=0.049], hyponatremia (OR: 3.027; 95% CI, 1.238-7.401; p=0.015), and being at clinical stage 4 (as defined by the World Health Organization) (OR: 9.492; 95% CI, 1.200-75.065; p=0.033) within the first six months of admission. CONCLUSION Special consideration should be given to patients who have active tuberculosis, are at clinical stage 4, and present with hyponatremia upon admission as these were found to be important factors associated with mortality within six months of hospital admission in HIV-1 patients.
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Affiliation(s)
- Ying Wen
- Department of Infectious Diseases, The First Affiliated Hospital, China Medical University, China
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