CD4+ cell count stratification to guide tuberculosis preventive therapy for people living with HIV

Chaisson, Lelia H.; Saraceni, Valéria; Cohn, Sylvia; Seabrook, Dena; Cavalcante, Solange; Chaisson, Richard E.; Golub, Jonathan E.; Durovni, Betina

doi:10.1097/qad.0000000000002398

Cited by 9 publications

(9 citation statements)

References 15 publications

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“…For PLWH, there is strong evidence of TPT beneficial effect in addition to ART on the reduction of TB risk, including among individuals with higher CD4 counts, especially in high TB burden country [ 3 , 4 , 5 , 25 , 29 ]. However, a recent analysis from WHO suggests that it is unlikely to achieve the TPT implementation targets in South‐East Asia Region by 2022 [ 30 ].…”

Section: Discussionmentioning

confidence: 99%

Incidence of active tuberculosis among people living with HIV receiving long‐term antiretroviral therapy in high TB/HIV burden settings in Thailand: implication for tuberculosis preventive therapy

et al. 2022

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Introduction Among high tuberculosis (TB) and HIV burden countries in Asia, tuberculosis preventive therapy (TPT) in people living with HIV (PLWH) has been underutilized despite its proven benefits independent of antiretroviral therapy (ART). Therefore, we determined the incidence of active TB and mortality among 9179 adult PLWH who attended and received ART from 15 tertiary care hospitals across Thailand. Methods A retrospective study was conducted in 2018 using follow‐up data from 1999 to 2018. The primary endpoint was incident TB disease after ART initiation. Factors associated with TB incidence were analysed using competing risk regression. The Kaplan–Meier method was used to estimate mortality after ART initiation. Results During a median of 5.1 years of ART (IQR 2.2–9.5 years), 442 (4.8%) PLWH developed TB (TB/HIV), giving an overall incidence of 750 (95% CI 683–823) per 100,000 persons‐year of follow up (PYFU). In multivariate analysis, lower CD4 at ART initiation (≤100 cells/mm 3 , adjusted sub‐distribution hazard ratio [aSHR]: 2.08, 95% CI, 1.47–2.92; 101–200 cells/mm 3 , aSHR: 2.21, 95% CI, 1.54–3.16; 201–350 cells/mm 3 , aSHR: 1.59, 95% CI, 1.11–2.28 vs. >350 cells/mm 3 ), male sex (aSHR: 1.40, 95% CI, 1.11–1.78), lower body weight (<50 kg, aSHR: 1.52, 95% CI, 1.17–1.95) and prior TB event (aSHR: 3.50, 95% CI, 2.72–4.52) were associated with TB incidence. PLWH with HIV RNA ≥50 copies/ml had 5–9 times higher risk of active TB disease higher than those with HIV RNA <50 copies/ml at the same CD4 level. The risk for developing TB was remarkably high during the initial period of ART (175,511 per 100,000 PYFU at<3 months) and was comparable to the general population after 10 years of ART (151 per 100,000 PYFU). TB/HIV had higher mortality (10% vs. 5%) and poorer HIV treatment outcomes: HIV RNA <50 copies/ml (63.8% vs. 82.8%), CD4 cells count (317 vs. 508 cells/mm 3 ) at the most recent visit. Conclusions In this high TB burden country, TB incidence was remarkably high during the first few years after ART initiation and thereafter decreased significantly. Rapid ART initiation and appropriate TPT can be potential key interventions to tackle the TB epidemic and reduce mortality among PLWH in TB/HIV high burden settings.

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Section: Discussionmentioning

confidence: 99%

Incidence of active tuberculosis among people living with HIV receiving long‐term antiretroviral therapy in high TB/HIV burden settings in Thailand: implication for tuberculosis preventive therapy

et al. 2022

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“…In 2018, data from the HIV care cascade in Brazil showed an estimate of 900,000 PLH, 66% of these on ART. There are no official or published data on the percentage of those who have completed one course of LTBI treatment but data from 2005 to 2009, from the THRio study, show that 48% have a CD4 cell count greater or equal to 350 cells/μl 17 . LTBI regimens currently recommended is 9 months of isoniazid or, for children under 15 years of age, adults over 50 years of age and those with liver disease, 4 months of rifampin.…”

Section: Methodsmentioning

confidence: 99%

Cost-effectiveness of newer technologies for the diagnosis of Mycobacterium tuberculosis infection in Brazilian people living with HIV

Steffen

Pinto

Kritski

et al. 2020

Sci Rep

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Tuberculosis is the leading cause of death among people living with HIV (PLH). Preventive tuberculosis therapy reduces mortality in PLH, especially in those with a positive tuberculin skin test (TST). New, more specific technologies for detecting latent tuberculosis infection (LTBI) are now commercially available. We sought to analyse the cost-effectiveness of four different strategies for the diagnosis of LTBI in PLH in Brazil, from the Brazilian public health care system perspective. We developed a Markov state-transition model comparing four strategies for the diagnosis of LTBI over 20 years. The strategies consisted of TST with the currently used protein purified derivative (PPD RT 23), two novel skin tests using recombinant allergens (Diaskintest [Generium Pharmaceutical, Moscow, Russia] and EC [Zhifei Longcom Biologic Pharmacy Co., Anhui, China]), and the QuantiFERON-TB-Gold-Plus (Qiagen, Hilden, Germany). The main outcome was cost (in 2020 US dollars) per quality-adjusted life years (QALY). For the base case scenario, the Diaskintest was dominant over all other examined strategies. The cost saving estimate per QALY was US $1375. In sensitivity analyses, the Diaskintest and other newer tests remained cost-saving compared to TST. For PLH, TST could be replaced by more specific tests in Brazil, considering the current national recommendations.

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“…Adherence has proven to be a key factor affecting HAART therapy [32], High adherence can reduce the number of drug-resistant strains and their further spread, can reduce opportunistic infections [33], reduce mortality and morbidity [34], reduce the cost of AIDS prevention and disease burden [32] [35]. Patients with chronic infectious diseases do not accept formal treatment is easy to lead to their own opportunistic infections are also easy to spread the disease, increased mortality and disease burden, easily lead to social instability.…”

Section: Application Of C50 Decision Tree Algorithm To Predict the Situation Of Patients With Chronic Infectious Diseasesmentioning

confidence: 99%

Study on the Grouping of Patients with Chronic Infectious Diseases Based on Data Mining

Li¹

2019

JBM

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Objective: According to RFM model theory of customer relationship management, data mining technology was used to group the chronic infectious disease patients to explore the effect of customer segmentation on the management of patients with different characteristics. Methods: 170,246 outpatient data was extracted from the hospital management information system (HIS) during January 2016 to July 2016, 43,448 data was formed after the data cleaning. K-Means clustering algorithm was used to classify patients with chronic infectious diseases, and then C5.0 decision tree algorithm was used to predict the situation of patients with chronic infectious diseases. Results: Male patients accounted for 58.7%, patients living in Shanghai accounted for 85.6%. The average age of patients is 45.88 years old, the high incidence age is 25 to 65 years old. Patients was gathered into three categories: 1) Clusters 1-Important patients (4786 people, 11.

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CD4+ cell count stratification to guide tuberculosis preventive therapy for people living with HIV

Cited by 9 publications

References 15 publications

Incidence of active tuberculosis among people living with HIV receiving long‐term antiretroviral therapy in high TB/HIV burden settings in Thailand: implication for tuberculosis preventive therapy

Incidence of active tuberculosis among people living with HIV receiving long‐term antiretroviral therapy in high TB/HIV burden settings in Thailand: implication for tuberculosis preventive therapy

Cost-effectiveness of newer technologies for the diagnosis of Mycobacterium tuberculosis infection in Brazilian people living with HIV

Study on the Grouping of Patients with Chronic Infectious Diseases Based on Data Mining

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