HIV care and treatment factors associated with improved survival during TB treatment in Thailand: an observational study

Varma, Jay K.; Nateniyom, Sriprapa; Akksilp, Somsak; Mankatittham, Wiroj; Sirinak, Chawin; Sattayawuthipong, Wanchai; Burapat, Channawong; Kittikraisak, Wanitchaya; Monkongdee, Patama; Cain, Kevin P.; Wells, Charles D.; Tappero, Jordan W.

doi:10.1186/1471-2334-9-42

Cited by 53 publications

(51 citation statements)

References 19 publications

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“…In other studies, the overall mortality was related to extrapulmonary TB, tuberculous meningitis, disseminated TB infection, MDR-TB, low CD4þ count and delay or failure to start cART. 7,18,19,35,36 Our study demonstrated that the only independent risk factor for death was disseminated infection. This finding might be explained by the fact that patients with disseminated infection would have a higher bacterial load of M. tuberculosis and thus more severe immunodeficiency status.…”

Section: Discussionmentioning

confidence: 81%

Treatment outcomes of patients co-infected with tuberculosis and HIV at Chiang Mai University Hospital, Thailand

Limmahakhun¹,

Chaiwarith²,

Nuntachit³

et al. 2012

Int J STD AIDS

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Thailand has been greatly affected by the tuberculosis (TB) and HIV syndemic. This study aimed to determine treatment outcomes among HIV/TB co-infected patients. A retrospective cohort study was conducted at Chiang Mai University Hospital from 1 January 2000 to 31 December 2009. Of 171 patients, 100 patients were male (58.5%) and the mean age was 36.8 ± 8.0 years. Seventy-two patients (42.1%) had pulmonary tuberculosis. Median CD4+ count before TB treatment was 69 cells/mm(3) (interquartile range [IQR] 33, 151). The overall mortality was 3.5% (6 patients). Immune reconstitution inflammatory syndrome (IRIS) occurred in eight patients (6.0%). Disseminated TB infections increased risk of death (odds ratio [OR] = 2.55, 95% confidence interval [CI] 1.25, 5.18) and IRIS (OR = 9.16, 95% CI 1.67, 50.07). Initiating combination antiretroviral therapy (cART) within two months after TB treatment increased risk of IRIS (OR = 6.57, 95% CI 1.61-26.86) and physicians caring for HIV/TB co-infected patients should be aware of this condition.

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Section: Discussionmentioning

confidence: 81%

Treatment outcomes of patients co-infected with tuberculosis and HIV at Chiang Mai University Hospital, Thailand

Limmahakhun¹,

Chaiwarith²,

Nuntachit³

et al. 2012

Int J STD AIDS

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“…Three studies explicitly reported on how death was ascertained or confirmed (Table 2) [38], [39], [45].…”

Section: Resultsmentioning

confidence: 99%

The Impact of Antiretroviral Therapy on Mortality in HIV Positive People during Tuberculosis Treatment: A Systematic Review and Meta-Analysis

et al. 2014

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ObjectiveTo quantify the impact of antiretroviral therapy (ART) on mortality in HIV-positive people during tuberculosis (TB) treatment.DesignWe conducted a systematic literature review and meta-analysis. Studies published from 1996 through February 15, 2013, were identified by searching electronic resources (Pubmed and Embase) and conference books, manual searches of references, and expert consultation. Pooled estimates for the outcome of interest were acquired using random effects meta-analysis.SubjectsThe study population included individuals receiving ART before or during TB treatment.Main Outcome MeasuresMain outcome measures were: (i) TB-case fatality ratio (CFR), defined as the proportion of individuals dying during TB treatment and, if mortality in HIV-positive people not on ART was also reported, (ii) the relative risk of death during TB treatment by ART status.ResultsTwenty-one studies were included in the systematic review. Random effects pooled meta-analysis estimated the CFR between 8% and 14% (pooled estimate 11%). Among HIV-positive TB cases, those receiving ART had a reduction in mortality during TB treatment of between 44% and 71% (RR = 0.42, 95%CI: 0.29–0.56).ConclusionStarting ART before or during TB therapy reduces the risk of death during TB treatment by around three-fifths in clinical settings. National programmes should continue to expand coverage of ART for HIV positive in order to control the dual epidemic.

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“…This view is supported by an observational study that showed no difference in mortality between HIV-infected patients with smear-positive and smear-negative pulmonary tuberculosis or extrapulmonary tuberculosis. 24 …”

Section: Discussionmentioning

confidence: 99%

Earlier versus Later Start of Antiretroviral Therapy in HIV-Infected Adults with Tuberculosis

Thim²,

et al. 2011

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Background Tuberculosis remains an important cause of death among patients infected with the human immunodeficiency virus (HIV). Robust data are lacking with regard to the timing for the initiation of antiretroviral therapy (ART) in relation to the start of antituberculosis therapy. Methods We tested the hypothesis that the timing of ART initiation would significantly affect mortality among adults not previously exposed to antiretroviral drugs who had newly diagnosed tuberculosis and CD4+ T-cell counts of 200 per cubic millimeter or lower. After beginning the standard, 6-month treatment for tuberculosis, patients were randomly assigned to either earlier treatment (2 weeks after beginning tuberculosis treatment) or later treatment (8 weeks after) with stavudine, lamivudine, and efavirenz. The primary end point was survival. Results A total of 661 patients were enrolled and were followed for a median of 25 months. The median CD4+ T-cell count was 25 per cubic millimeter, and the median viral load was 5.64 log10 copies per milliliter. The risk of death was significantly reduced in the group that received ART earlier, with 59 deaths among 332 patients (18%), as compared with 90 deaths among 329 patients (27%) in the later-ART group (hazard ratio, 0.62; 95% confidence interval [CI]; 0.44 to 0.86; P = 0.006). The risk of tuberculosis-associated immune reconstitution inflammatory syndrome was significantly increased in the earlier-ART group (hazard ratio, 2.51; 95% CI, 1.78 to 3.59; P<0.001). Irrespective of the study group, the median gain in the CD4+ T-cell count was 114 per cubic millimeter, and the viral load was undetectable at week 50 in 96.5% of the patients. Conclusions Initiating ART 2 weeks after the start of tuberculosis treatment significantly improved survival among HIV-infected adults with CD4+ T-cell counts of 200 per cubic millimeter or lower. (Funded by the French National Agency for Research on AIDS and Viral Hepatitis and the National Institutes of Health; CAMELIA ClinicalTrials.gov number, NCT01300481.)

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HIV care and treatment factors associated with improved survival during TB treatment in Thailand: an observational study

Cited by 53 publications

References 19 publications

Treatment outcomes of patients co-infected with tuberculosis and HIV at Chiang Mai University Hospital, Thailand

Treatment outcomes of patients co-infected with tuberculosis and HIV at Chiang Mai University Hospital, Thailand

The Impact of Antiretroviral Therapy on Mortality in HIV Positive People during Tuberculosis Treatment: A Systematic Review and Meta-Analysis

Earlier versus Later Start of Antiretroviral Therapy in HIV-Infected Adults with Tuberculosis

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