Incidence and determinants of mortality and morbidity following early antiretroviral therapy initiation in HIV-infected adults in West Africa

Moh, Raoul; Danel, Christine; Messou, Eugène; Ouassa, Timothée; Gabillard, Delphine; Anzian, Amani; Abo, Yao; Salamon, Roger; Bissagnené, E.; Seyler, Catherine; Eholié, Serge; Anglaret, Xavier

doi:10.1097/qad.0b013e3282f09876

Cited by 123 publications

(124 citation statements)

References 27 publications

(35 reference statements)

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“…4 Low body mass index (BMI < 18 kg/m 2 ) has also been associated with early mortality. [6][7][8][9][10][11][12][13] Unfortunately, only 45% of HIVinfected people know their status, which contributes to the still significant proportion (30%) with a CD4 count < 100 cells/μL at presentation despite raising the CD4 threshold for initiating treatment particularly in men. 14,15 Tuberculosis (TB) is a common cause of ART-associated death [16][17][18] among HIV-infected people in SSA, particularly in east and southern Africa.…”

Section: Introductionmentioning

confidence: 99%

Prevention of Early Mortality by Presumptive Tuberculosis Therapy Study: An Open Label, Randomized Controlled Trial

Manabe

Worodria

Leth

et al. 2016

The American Society of Tropical Medicine and Hygiene

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Abstract. Early mortality after initiation of antiretroviral therapy (ART) occurs in 9-39% of patients in sub-Saharan Africa. A significant proportion of deaths are attributable to tuberculosis (TB). Low baseline CD4 T-cell count and low body mass index (BMI) are strongly associated with early mortality. We hypothesized that initiation of ART concurrent with presumptive anti-TB chemotherapy in high-risk patients would reduce mortality within the first 6 months by treating unrecognized TB. From October 2011 to December 2012, ART-naive, smear-negative participants with a CD4 T-cell count < 50 cells/μL and BMI < 18 kg/m 2 were randomly assigned to undergo either empiric four-drug anti-TB treatment followed 2 weeks later by efavirenz-based ART (N = 23) (ART + TB) or ART only (N = 20). This open-label, 1:1 randomized, controlled trial took place in Uganda, Mozambique, and Gabon and was stopped prematurely by the sponsor for slow recruitment. Overall, the 43 participants had a median CD4 of 22 (interquartile range [IQR]: 9-35) cells/μL and a median BMI of 17.5 (IQR: 16.6-18.0) kg/m 2 . The mortality was 14% (95% confidence interval [CI]: 5.3-27.9); two (10.0%) participants (ART-only group), and four (17.4%; ART + TB group). The associated hazard ratio (HR) for all-cause mortality was 1.6 (95% CI: 0.30-8.90). Despite limited enrollment, the study did not suggest that empiric TB treatment in severely immunosuppressed patients with low BMI decreased mortality and, had an HR in the opposite direction than expected. Notably, two participants in the ART + TB group died with autopsy-confirmed drug-induced hepatotoxicity. Improved TB diagnostics sensitive in immunosuppressed patients presenting late to care are urgently needed for more targeted interventions.

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Section: Introductionmentioning

confidence: 99%

Prevention of Early Mortality by Presumptive Tuberculosis Therapy Study: An Open Label, Randomized Controlled Trial

Manabe

Worodria

Leth

et al. 2016

The American Society of Tropical Medicine and Hygiene

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“…Similarly, other studies in Ethiopia [27,31] showed that there is higher mortality in patients with lower baseline functional status similar to the present study. Two other studies in Africa showed that patients who experienced severe morbidity and hence poor performance at presentation to health facilities had higher risks of mortality [32,33] highlighting the need for early presentation and screening for HIV as well as TB of the general population in Africa.…”

Section: Discussionmentioning

confidence: 99%

Mortality of Adults on Antiretroviral Therapy with and without TB coinfection in Jimma University Hospital, Ethiopia: Retrospective Cohort Study

Lenjisa¹,

Wega²,

Lema³

et al. 2014

J AIDS Clin Res

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“…UNMASKING TB-IRIS High TB incidence rates (5.6-23 TB cases per 100 person-yrs) in the first 3 months of ART have been reported in developing country ART programmes [246,247]. TB is an important cause of the high mortality observed during early ART in these settings [248].…”

Section: Tb-associated Immune Reconstitution Inflammatory Syndromementioning

confidence: 99%

Clinical management of tuberculosis and HIV-1 co-infection

Schutz¹,

Meintjes²,

Almajid³

et al. 2010

Eur Respir J

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In many parts of the world the commonest serious opportunistic infection that occurs in HIV-1 infected persons is tuberculosis (TB). HIV-1 co-infection modifies the natural history and clinical presentation, and adversely affects the outcome of TB. Severe disseminated disease is well-recognised but it is increasingly appreciated that early disease characterised by very few or no symptoms is also common. Immunodiagnostic methods to ascertain latent TB in HIV-1 infected persons are compromised in sensitivity.Chemoprevention of HIV-1-associated TB is effective, its benefits are restricted to those which have evidence of immune sensitisation and appear short-lived in areas of high TB burden. Although promising advances in the microbiological diagnosis of TB have recently occurred, the diagnosis of HIV-1-associated TB remains difficult because of more frequent presentation as sputum negative or extrapulmonary disease.Management of co-infected patients can be complex because of overlapping drug toxicities and interactions. Nevertheless consensus is developing that antiretroviral therapy should be provided as soon as practicable after starting TB treatment in HIV-1 co-infected persons. This has the consequence of increasing the frequency of immune reconstitution inflammatory syndrome, the pathogenesis and management of which is poorly defined.

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Incidence and determinants of mortality and morbidity following early antiretroviral therapy initiation in HIV-infected adults in West Africa

Cited by 123 publications

References 27 publications

Prevention of Early Mortality by Presumptive Tuberculosis Therapy Study: An Open Label, Randomized Controlled Trial

Prevention of Early Mortality by Presumptive Tuberculosis Therapy Study: An Open Label, Randomized Controlled Trial

Mortality of Adults on Antiretroviral Therapy with and without TB coinfection in Jimma University Hospital, Ethiopia: Retrospective Cohort Study

Clinical management of tuberculosis and HIV-1 co-infection

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