Incidence and risk factors for tuberculosis in HIV-infected patients while on antiretroviral treatment in Cambodia

BackgroundFor settings with limited laboratory capacity, 2013 World Health Organization (WHO) guidelines recommend targeted HIV-1 viral load (VL) testing to identify virological failure. We previously developed and validated a clinical prediction score (CPS) for targeted VL testing, relying on clinical, adherence and laboratory data. While outperforming the WHO failure criteria, it required substantial calculation and review of all previous laboratory tests. In response, we developed four simplified, less error-prone and broadly applicable CPS versions that can be done ‘on the spot’.Methodology/PrincipalFindings From May 2010 to June 2011, we validated the original CPS in a non-governmental hospital in Phnom Penh, Cambodia applying the CPS to adults on first-line treatment >1 year. Virological failure was defined as a single VL >1000 copies/ml. The four CPSs included CPS1 with ‘current CD4 count’ instead of %-decline-from-peak CD4; CPS2 with hemoglobin measurements removed; CPS3 having ‘decrease in CD4 count below baseline value’ removed; CPS4 was purely clinical. Score development relied on the Spiegelhalter/Knill-Jones method. Variables independently associated with virological failure with a likelihood ratio ≥1.5 or ≤0.67 were retained. CPS performance was evaluated based on the area-under-the-ROC-curve (AUROC) and 95% confidence intervals (CI). The CPSs were validated in an independent dataset. A total of 1490 individuals (56.6% female, median age: 38 years (interquartile range (IQR 33–44)); median baseline CD4 count: 94 cells/µL (IQR 28–205), median time on antiretroviral therapy 3.6 years (IQR 2.1–5.1)), were included. Forty-five 45 (3.0%) individuals had virological failure. CPS1 yielded an AUROC of 0.69 (95% CI: 0.62–0.75) in validation, CPS2 an AUROC of 0.68 (95% CI: 0.62–0.74), and CPS3, an AUROC of 0.67 (95% CI: 0.61–0.73). The purely clinical CPS4 performed poorly (AUROC-0.59; 95% CI: 0.53–0.65).ConclusionsSimplified CPSs retained acceptable accuracy as long as current CD4 count testing was included. Ease of field application and field accuracy remains to be defined.

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“…All care was provided by physicians. More information on the program has been published before [15]–[17].…”

Section: Methodsmentioning

confidence: 99%

Simplified Clinical Prediction Scores to Target Viral Load Testing in Adults with Suspected First Line Treatment Failure in Phnom Penh, Cambodia

et al. 2014

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“…The risk of TB in HIV‐positive persons has been extensively reviewed . Its reported association with one's immunological status, as reflected by CD4 count and advanced CDC stage (or acquired immune deficiency syndrome (AIDS) stage), was confirmed in studies in African and Asian countries including Ethiopia, China and Cambodia . Other risk factors include smoking, silicosis and recent contacts with TB transmitters who may not be HIV‐infected .…”

Section: Disease Burden Of Tb/hiv Co‐infectionsmentioning

confidence: 99%

“…5 Its reported association with one's immunological status, as reflected by CD4 count and advanced CDC stage (or acquired immune deficiency syndrome (AIDS) stage), was confirmed in studies in African and Asian countries including Ethiopia, 6 China 7 and Cambodia. 8 Other risk factors include smoking, silicosis and recent contacts with TB transmitters who may not be HIV-infected. 5 Sociodemographic characteristics also play a role, as reflected by a higher incidence in occupations with higher TB prevalence, for example, miners, and immigrants from higher prevalence countries, and people who use drugs.. 9,10 Male gender was associated with TB/HIV co-infection, reflecting the gender association in TB generally.…”

Section: Disease Burden Of Tb/hiv Co-infectionsmentioning

confidence: 99%

Management of tuberculosis and latent tuberculosis infection in human immunodeficiency virus‐infected persons

et al. 2013

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The syndemic of human immunodeficiency virus (HIV)/tuberculosis (TB) co-infection has grown as a result of the considerable sociogeographic overlaps between the two epidemics. The situation is particularly worrisome in countries with high or intermediate TB burden against the background of a variable HIV epidemic state. Early diagnosis of TB disease in an HIVinfected person is paramount but suffers from lack of sensitive and specific diagnostic tools. Enhanced symptom screening is currently advocated, and the wide application of affordable molecular diagnostics is urgently needed. Treatment of TB/HIV co-infection involves the concurrent use of standard antiretrovirals and antimycobacterials during which harmful drug interaction may occur. The pharmacokinetic interaction between rifamycin and antiretrovirals is a case in point, requiring dosage adjustment and preferential use of rifabutin, if available. Early initiation of antiretroviral therapy is indicated, preferably at 2 weeks after starting TB treatment for patients with a CD4 of <50 cells/mL. Development of TB-immune reconstitution inflammatory syndrome (TB-IRIS) is however more frequent with early antiretroviral therapy. The diagnosis of TB-IRIS is another clinical challenge, and cautious use of corticosteroids is suggested to improve clinical outcome. As a preventive measure against active TB disease, the screening for latent TB infection should be widely practiced, followed by at least 6-9 months of isoniazid treatment. To date tuberculin skin test remains the only diagnostic tool in high TB burden countries. The role of alternative tests, for example, interferon-g release assay, would need to be better defined for clinical application.

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“…Besides, studies has also found that, the lower base line CD4 cell count and at advanced WHO staging of HIV of individuals also contributes to the development of TB among PLHIV [10,12,[18][19][20][21][22][23]. Furthermore lower base line hemoglobin level (<12 g/dl) and base line Body Mass Index (BMI) less than 18.5 kg/m 2 was also shown to have an association with TB infection [18,21,23,24]. Sociodemographic factors have association with TB infection In addition to clinical factors.…”

Section: Introductionmentioning

confidence: 99%

Assessing the Effect of Highly Active Anti-Retroviral Treatment and Associated Factors on Incidence of Tuberculosis among Adult HIV Positive Individuals in Assela, Ethiopia

Abebe¹

2014

J Health Med Informat

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Background: Study done in Ethiopia in Southern Nation Nationality People (SNNP) during 2003 showed the incidence of TB among those on HAART was lower (3.70 cases of TB per 100 person years) than those, on pre-HAART (11.1 cases of TB per 100 PYO). Besides being on HAART or pre HAART different socio demographic, substance use and clinical factors play an important role in developing TB infection among PLHIV. So, the objective of this study was to assess the effect of HAART on incidence of TB among people living with HIV/AIDS. 1.2 Methods: A retrospective cohort study was conducted at Assela referral Hospital among patients enrolled on HIV care and support during September 13/2005 to January 30/2011. A total of 412 patients' record from the HAART and pre HAART group were selected in one to one ratio by simple random sampling method. Kaplan Meier and proportional cox regression methods were used to determine the predictor of TB incidence.Result: The incidence of tuberculosis was 7.02/100 person years (95% CI: 5.02, 9.83) among those on pre HAART follow up where as it was 3.73/100 person years among those on HAART. Furthermore, individuals on HAART have a 96.8% decrease in risk of tuberculosis, (AHR=0.032; 95% CI: 0.012, 0.082) than those non-HAART individuals. Similarly CD4 cell count <200 cell/µl and WHO clinical stage III or IV has statistically significant association with TB development among People living with HIV/AIDS. Conclusion and recommendation:HAART use decreased tuberculosis incidence among HIV positive individuals. In addition, CD4 cell count <200 cell/µl and WHO clinical stage III or IV were factors associated with the development of new TB cases among PLHIV. So, HAART should be started with a higher CD4 cell count and none advanced WHO clinical stage in order to get maximum reduction of new TB cases among PLHIV.

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Incidence and risk factors for tuberculosis in HIV-infected patients while on antiretroviral treatment in Cambodia

Cited by 19 publications

References 28 publications

Simplified Clinical Prediction Scores to Target Viral Load Testing in Adults with Suspected First Line Treatment Failure in Phnom Penh, Cambodia

Simplified Clinical Prediction Scores to Target Viral Load Testing in Adults with Suspected First Line Treatment Failure in Phnom Penh, Cambodia

Management of tuberculosis and latent tuberculosis infection in human immunodeficiency virus‐infected persons

Assessing the Effect of Highly Active Anti-Retroviral Treatment and Associated Factors on Incidence of Tuberculosis among Adult HIV Positive Individuals in Assela, Ethiopia

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