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Salindri AD, Kipiani M, Lomtadze N, Tukvadze N, Avaliani Z, Blumberg HM, Masyn KE, Rothenberg RB, Kempker RR, Magee MJ. HIV co-infection increases the risk of post-tuberculosis mortality among persons who initiated treatment for drug-resistant tuberculosis. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2023.05.19.23290190. [PMID: 37293036 PMCID: PMC10246159 DOI: 10.1101/2023.05.19.23290190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Little is known regarding the relationship between common comorbidities in persons with tuberculosis (TB) (including human immunodeficiency virus [HIV], diabetes, and hepatitis C virus [HCV]) with post-TB mortality. We conducted a retrospective cohort study among persons who initiated treatment for rifampicin-resistant and multi/extensively drug-resistant (RR and M/XDR) TB reported to the country of Georgia's TB surveillance during 2009-2017. Exposures included HIV serologic status, diabetes, and HCV status. Our outcome was all-cause post-TB mortality determined by cross-validating vital status with Georgia's death registry through November 2019. We estimated adjusted hazard rate ratios (aHR) and 95% confidence intervals (CI) of post-TB mortality among participants with and without comorbidities using cause-specific hazard regressions. Among 1032 eligible participants, 34 (3.3%) died during treatment and 87 (8.7%) died post-TB treatment. Among those who died post-TB treatment, the median time to death was 21 months (interquartile range 7-39) post-TB treatment. After adjusting for confounders, the hazard rates of post-TB mortality were higher among participants with HIV co-infection (aHR=3.74, 95%CI 1.77-7.91) compared to those without HIV co-infection. In our cohort, post-TB mortality occurred most commonly in the first three years post-TB treatment. Linkage to care for common TB comorbidities post-treatment may reduce post-TB mortality rates.
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Affiliation(s)
- Argita D. Salindri
- Department of Population Health Sciences, Georgia State University School of Public Health, Atlanta, GA, USA; and Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Maia Kipiani
- National Center for Tuberculosis and Lung Diseases, Tbilisi, Georgia; David Tvildiani Medical University, Tbilisi, Georgia; and The University of Georgia, Tbilisi, Georgia
| | - Nino Lomtadze
- National Center for Tuberculosis and Lung Diseases, Tbilisi, Georgia; David Tvildiani Medical University, Tbilisi, Georgia; and The University of Georgia, Tbilisi, Georgia
| | - Nestani Tukvadze
- National Center for Tuberculosis and Lung Diseases, Tbilisi, Georgia; and Department of Medicine, Swiss Tropical and Public Health Institute, Allschwil, Switzerland
| | - Zaza Avaliani
- National Center for Tuberculosis and Lung Diseases, Tbilisi, Georgia; and European University, Tbilisi, Georgia
| | - Henry M. Blumberg
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA; Hubert Department of Global Health and Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Katherine E. Masyn
- Department of Population Health Sciences, Georgia State University School of Public Health, Atlanta, GA, USA, Atlanta, GA, USA
| | - Richard B. Rothenberg
- Department of Population Health Sciences, Georgia State University School of Public Health, Atlanta, GA, USA, Atlanta, GA, USA
| | - Russell R. Kempker
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Matthew J. Magee
- Hubert Department of Global Health and Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA, USA; and Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
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Romanowski K, Amin P, Johnston JC. Améliorer les soins post-tuberculose au Canada. CMAJ 2023; 195:E217-E219. [PMID: 36746479 PMCID: PMC9904809 DOI: 10.1503/cmaj.220739-f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Affiliation(s)
- Kamila Romanowski
- Département de médecine (Romanowski, Johnston), Université de la Colombie-Britannique; Services provinciaux pour la TB, BC Centre for Disease Control (Romanowski, Johnston), Vancouver, C.-B.; Stop TB Canada (Amin); TB People Canada (Amin); Association pulmonaire du Canada (Amin), Ottawa, Ont
| | - Priya Amin
- Département de médecine (Romanowski, Johnston), Université de la Colombie-Britannique; Services provinciaux pour la TB, BC Centre for Disease Control (Romanowski, Johnston), Vancouver, C.-B.; Stop TB Canada (Amin); TB People Canada (Amin); Association pulmonaire du Canada (Amin), Ottawa, Ont
| | - James C Johnston
- Département de médecine (Romanowski, Johnston), Université de la Colombie-Britannique; Services provinciaux pour la TB, BC Centre for Disease Control (Romanowski, Johnston), Vancouver, C.-B.; Stop TB Canada (Amin); TB People Canada (Amin); Association pulmonaire du Canada (Amin), Ottawa, Ont.
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Romanowski K, Amin P, Johnston JC. Improving post-tuberculosis care in Canada. CMAJ 2022; 194:E1617-E1618. [PMID: 36507787 PMCID: PMC9828977 DOI: 10.1503/cmaj.220739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Affiliation(s)
- Kamila Romanowski
- Department of Medicine (Romanowski, Johnston), University of British Columbia; Provincial TB Services, BC Centre for Disease Control (Romanowski, Johnston), Vancouver, BC; Stop TB Canada (Amin); TB People Canada (Amin); The Canadian Lung Association (Amin), Ottawa, Ont
| | - Priya Amin
- Department of Medicine (Romanowski, Johnston), University of British Columbia; Provincial TB Services, BC Centre for Disease Control (Romanowski, Johnston), Vancouver, BC; Stop TB Canada (Amin); TB People Canada (Amin); The Canadian Lung Association (Amin), Ottawa, Ont
| | - James C Johnston
- Department of Medicine (Romanowski, Johnston), University of British Columbia; Provincial TB Services, BC Centre for Disease Control (Romanowski, Johnston), Vancouver, BC; Stop TB Canada (Amin); TB People Canada (Amin); The Canadian Lung Association (Amin), Ottawa, Ont.
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Basham CA, Karim ME, Cook VJ, Patrick DM, Johnston JC. Post-tuberculosis airway disease: A population-based cohort study of people immigrating to British Columbia, Canada, 1985-2015. EClinicalMedicine 2021; 33:100752. [PMID: 33718847 PMCID: PMC7933261 DOI: 10.1016/j.eclinm.2021.100752] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 01/23/2021] [Accepted: 01/26/2021] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND Current epidemiological evidence of post-TB airway disease is largely cross-sectional and derived from high-TB-incidence settings. We present the first cohort study of post-TB airway disease in a low-TB-incidence setting. AIMS (1) analyze the risk of airway disease by respiratory TB, (2) assess potential unmeasured confounding between TB and airway disease, and (3) investigate TB effect measure modification. METHODS A population-based cohort study using healthcare claims data for immigrants to British Columbia (BC), Canada, 1985-2015. Airway disease included chronic airway obstruction, asthma, bronchitis, bronchiolitis, and emphysema. Respiratory TB was defined from TB registry data. Cox proportional hazards (PH) regressions were used to analyze time-to-airway disease by respiratory TB. Sensitivity analyses included varying definitions of TB and airway disease. Potential unmeasured confounding by smoking was evaluated by E-value and hybrid least absolute shrinkage and selection operator (LASSO)-high-dimensional propensity score (hdPS). FINDINGS In our cohort (N = 1 005 328; nTB=1141) there were 116 840 incident cases of airway disease during our 30-year study period (10.43 per 1,000 person-years of follow-up), with cumulative incidence of 42·5% among respiratory TB patients compared with 11·6% among non-TB controls. The covariate-adjusted hazard ratio (aHR) for airway disease by respiratory TB was 2·08 (95% CI: 1·91-2·28) with E-value=3·58. The LASSO-hdPS analysis produced aHR=2·26 (95% CI: 2·07-2·47). INTERPRETATION A twofold higher risk of airway disease was observed among immigrants diagnosed with respiratory TB, compared with non-TB controls, in a low-TB-incidence setting. Unmeasured confounding is unlikely to explain this relationship. Models of post-TB care are needed. FUNDING Canadian Institutes of Health Research.
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Affiliation(s)
- C. Andrew Basham
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
- British Columbia Centre for Disease Control, Vancouver, Canada
- Corresponding author at: 655W 12th Avenue, Vancouver, British Columbia, V5Z 4R4 Canada.
| | - Mohammad E. Karim
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
- Centre for Health Evaluative and Outcome Sciences, University of British Columbia, Vancouver, Canada
| | - Victoria J. Cook
- British Columbia Centre for Disease Control, Vancouver, Canada
- Department of Medicine, University of British Columbia, Vancouver, Canada
| | - David M. Patrick
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
- British Columbia Centre for Disease Control, Vancouver, Canada
- Department of Medicine, University of British Columbia, Vancouver, Canada
| | - James C. Johnston
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
- British Columbia Centre for Disease Control, Vancouver, Canada
- Department of Medicine, University of British Columbia, Vancouver, Canada
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