Early Initiation of ARV Therapy Among TB–HIV Patients in Indonesia Prolongs Survival Rates!

Maemun, Siti; Mariana, Nina; Rusli, Arjulizan; Mahkota, Renti; Purnama, Tri Bayu

doi:10.2991/jegh.k.200102.002

Cited by 4 publications

(4 citation statements)

References 8 publications

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“…Similar to previous studies, [ 25 , 26 ] our multivariate model demonstrated that ART initiation was significantly associated with higher odds of mortality among HIV-positive TB patients. Based on the available evidence, the European AIDS clinical society recommends the following: “ART should be started as soon as possible (within 2 weeks of initiating TB treatment) regardless of CD4 count.…”

Section: Discussionsupporting

confidence: 89%

“…[24] Tuberculosis can occur at any CD4 cell level; however, when CD4 levels are low, infection with other pathogens progresses As a result, when CD4 cell levels are low, in addition to active highly active ART and anti-TB therapy, the patient's immune system should be improved to enhance the treatment of other pathogens and reduce the occurrence of death. Similar to previous studies, [25,26] our multivariate model demonstrated that ART initiation was significantly associated with higher odds of mortality among HIV-positive TB patients. Based on the available evidence, the European AIDS clinical society recommends the following: "ART should be started as soon as possible (within 2 weeks of initiating TB treatment) regardless of CD4 count.…”

Section: Discussionsupporting

confidence: 89%

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Predictors of death among TB/HIV co-infected patients on tuberculosis treatment in Sichuan, China: A retrospective cohort study

Yang

Zhong

et al. 2023

Medicine

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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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Section: Discussionsupporting

confidence: 89%

Section: Discussionsupporting

confidence: 89%

Predictors of death among TB/HIV co-infected patients on tuberculosis treatment in Sichuan, China: A retrospective cohort study

Yang

Zhong

et al. 2023

Medicine

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“…[ 29 30 31 ] It has also been shown that survival in HIV-TB co-infected can be improved by initiating ART at an appropriate time after starting of TB treatment. [ 27 32 ] Furthermore, treating physicians should use clinical judgement while starting ART to avoid mortality due Immune Reconstitution Syndrome. [ 33 ] Baseline CD4 counts at the time of diagnosis was another factor associated with mortality in our study population.…”

Section: Discussionmentioning

confidence: 99%

Factors associated with survival in adult people living with HIV/AIDS (PLHAs) in Mumbai, India (2004-2019)

Acharya

Palkar

Keskar

et al. 2021

Journal of Family Medicine and Primary Care

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Background: Knowledge of factors that affect survival in People living with HIV/AIDS (PLHAs) on anti-retroviral therapy (ART) will help us develop and implement interventions to improve the clinical outcomes and survival in these individuals. The aim of this study was to estimate the survival in PLHAs on ART in the government ART programme in Mumbai, and the factors associated with survival in these individuals. Methods: It is a retrospective survival analysis of 28,345 adult PLHAs from 18 government ART centres in Mumbai (registration period 2004–2019). We estimated the mortality rates and their 95% confidence intervals [CIs], plotted the Kaplan Meier Survival curves, estimated incidence rate ratios (IRR) and hazard ratios (HR). There were done for the whole cohort and according to various demographic and clinical characteristics. Results: The mortality in PLHAs on ART was 9.04 per 1000 person years. The HR was significantly for those aged 50 years and more at the time of registration (HR: 3.01, 95% CI: 2.37, 3.83; P < 0.001), in those with baseline CD4 count of less than 200 higher hazard (HR: 1.83, 95% CI: 1.47, 2.27; P < 0.001), those with an adherence of 80–95% (HR; 5.58, 95% CI: 4.61, 6.75; P < 0.001) and adherence of <80% (HR: 9.37, 95% CI: 7.74, 11.33; P < 0.001). Furthermore, the hazard was significantly higher in those with TB compared those without TB (HR: 3.28, 95% CI: 2.87, 3.75; P < 0.001). Time from diagnosis (per month increase) to initiation of ART was not significantly associated with mortality. Conclusions: Increasing awareness about HIV testing and early detection of HIV in those who have high-risk behaviours, prompt diagnosis and management of TB among those infected, and developing and implementing strategies (such as enhanced counselling, telephone-based applications, messages, or reminders) to ensure ART adherence of more than 95% in those on ART will potentially help improve survival in PLHAs in India.

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“…Antiretroviral therapy had more People Living with HIV (PLHIV) and thus it was anticipated that the incidence and mortality will decrease. Preexposure prophylaxis, viral suppression leading to the concept of ‘Undetectable = Untransmittable’ (U = U), and antenatal regimens were expected to further reduce the transmission of the virus [ 10 , 11 ]. HIV infections vary by regions, even within countries [ 12 , 13 ].…”

Section: Introductionmentioning

confidence: 99%

Global Epidemiology of HIV/AIDS: A Resurgence in North America and Europe

Govender

Hashim

Khan

et al. 2021

JEGH

128

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We aimed to assess global trends in Human Immunodeficiency Virus (HIV)/Acquired Immune Deficiency Syndrome (AIDS) and evaluate progress toward eradication since the inception of the pandemic. Data were extracted from the Global Burden of Disease 2019 update and the UNAIDS Data 2019. The datasets included annual figures from 1990 to 2019 for HIV/AIDS in 204 countries and all world regions. We analyzed rates and trends for prevalence, incidence, mortality and disability adjusted life years. Analysis of age and gender distribution in different regions was used to assess demographic changes. Forecasting was used to estimate disease burden up to 2040. Although many countries have witnessed a decrease in the incidence, for Russia, Ukraine, Portugal, Brazil, Spain and the United States, the rates of new cases are rising since 2010. This trend is present even in age-standardized analysis, indicating a rise in excess of population growth. Over 0.5% of the world's population is infected. About 5000 new infections occur daily, of which 500 are children. Mortality rates are falling globally; currently at 11 deaths per 100,000 population, forecasted to decrease to 8.5 deaths by 2040. Prevalence continues to increase, with South Africa, Nigeria, Mozambique, India, Kenya and the United States having the highest burden. The total number as well as the rates of new HIV infections are rising every year in Europe, South America, North America and other regions over the last decade. Maternal-tochild transmission continues at high rates despite effective preventive regimens. There is an urgent need to develop programs to curb the rising incidence of HIV.

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Early Initiation of ARV Therapy Among TB–HIV Patients in Indonesia Prolongs Survival Rates!

Cited by 4 publications

References 8 publications

Predictors of death among TB/HIV co-infected patients on tuberculosis treatment in Sichuan, China: A retrospective cohort study

Predictors of death among TB/HIV co-infected patients on tuberculosis treatment in Sichuan, China: A retrospective cohort study

Factors associated with survival in adult people living with HIV/AIDS (PLHAs) in Mumbai, India (2004-2019)

Global Epidemiology of HIV/AIDS: A Resurgence in North America and Europe

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