Tuberculosis in HIV-infected persons in British Columbia during the HAART era

Cheng, Matthew P.; Hirji, A.; Roth, David; Cook, Victoria; Lima, Viviane D.; Montaner, Julio S. G.; Johnston, James C.

doi:10.17269/cjph.105.4260

Cited by 6 publications

(7 citation statements)

References 22 publications

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“…The compliance figures of LTBI screening in Hong Kong (84%) appeared to be higher than that of other developed countries (<70%) 11–13,15 . Nonetheless, the prevalence of LTBI in this study (32%) was similar to nearby Asian places (Iran, Korea, Thailand, Taiwan) 21,22 , and the proportion of TB cases with LTBI testing history (56%) was close to that of a Canadian study (61%) 14 .…”

Section: Discussionsupporting

confidence: 76%

“…Time dependent variables of DM and ADI diagnoses were manipulated and included for analyses. In light of the significant association of HAART coverage with TB incidence 14 , we included HAART status (time dependent) and LTBI treatment status as confounders in multivariable Cox regression models. Separately, characteristics of patients ever tested and never tested for LTBI were compared, and the associated factors of the positive LTBI testing results were explored in logistic regression models.…”

Section: Methodsmentioning

confidence: 99%

“…With highly active antiretroviral therapy (HAART), immune recovery is becoming an achievable outcome 16,17 . HAART could potentially slow LTBI progression, thus reducing TB disease incidence 14,18,19 . In a Canadian study, the TB incidence fell following HAART coverage expansion 14 .…”

Section: Introductionmentioning

confidence: 99%

“…HAART could potentially slow LTBI progression, thus reducing TB disease incidence 14,18,19 . In a Canadian study, the TB incidence fell following HAART coverage expansion 14 . The need for regular LTBI screening may not be as important with HAART.…”

Section: Introductionmentioning

confidence: 99%

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A longitudinal study on latent TB infection screening and its association with TB incidence in HIV patients

Wong

Leung

Chan

et al. 2019

Sci Rep

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Latent TB infection (LTBI) in HIV patients, its treatment, and immunological recovery following highly active antiretroviral therapy (HAART) could interact and impact TB disease progression. We aim to examine the factors associated with LTBI and TB disease development among HIV patients. Longitudinal clinical and laboratory data were accessed from the largest HIV specialist clinic in Hong Kong, where HAART and yearly LTBI screening are routinely provided for HIV patients. Between 2002 and mid-2017, among 2079 HIV patients with 14119 person-years (PY) of follow-up, 32% of LTBI screened patients (n = 1740) were tested positive. The overall TB incidence was 1.26/100 PY from HIV diagnosis to HAART initiation, falling to 0.37/100 PY. A lower risk of TB disease progression was associated with local residence, Chinese ethnicity, negative baseline LTBI result, being on HAART, LTBI treatment, higher baseline CD4 and CD4/CD8 ratio. A positive test at baseline, but not subsequent testing results, was significantly associated with TB disease development. Baseline LTBI screening is an important strategy for identifying HIV patients at risk of TB disease progression. Routine repeat LTBI screening on an annual basis might not give additional benefits to patients on HAART with good immunological responses. Such practice should require re-evaluation.

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Section: Discussionsupporting

confidence: 76%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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A longitudinal study on latent TB infection screening and its association with TB incidence in HIV patients

Wong

Leung

Chan

et al. 2019

Sci Rep

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“…However, we believe that if patients in both of these settings are offered the same ART regimens, biologically, there is no difference in how they will respond to therapy. Eighth, in BC, in comparison with resource-limited settings, tuberculosis co-infection is relatively rare [ 40 , 41 ]. Although there is extensive documentation regarding the interaction between different tuberculosis and HIV medications, antiretroviral treatment outcomes are highly heterogeneous among co-infected individuals and highly dependent on treatment adherence.…”

Section: Discussionmentioning

confidence: 99%

Long‐term effectiveness of initiating non‐nucleoside reverse transcriptase inhibitor‐ versus ritonavir‐boosted protease inhibitor‐based antiretroviral therapy: implications for first‐line therapy choice in resource‐limited settings

Lima

Hull

McVea

et al. 2016

Journal of the International AIDS Society

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IntroductionIn many resource-limited settings, combination antiretroviral therapy (cART) failure is diagnosed clinically or immunologically. As such, there is a high likelihood that patients may stay on a virologically failing regimen for a substantial period of time. Here, we compared the long-term impact of initiating non-nucleoside reverse transcriptase inhibitor (NNRTI)- versus boosted protease inhibitor (bPI)-based cART in British Columbia (BC), Canada.MethodsWe followed prospectively 3925 ART-naïve patients who started NNRTIs (N=1963, 50%) or bPIs (N=1962; 50%) from 1 January 2000 until 30 June 2013 in BC. At six months, we assessed whether patients virologically failed therapy (a plasma viral load (pVL) >50 copies/mL), and we stratified them based on the pVL at the time of failure ≤500 versus >500 copies/mL. We then followed these patients for another six months and calculated their probability of achieving subsequent viral suppression (pVL <50 copies/mL twice consecutively) and of developing drug resistance. These probabilities were adjusted for fixed and time-varying factors, including cART adherence.ResultsAt six months, virologic failure rates were 9.5 and 14.3 cases per 100 person-months for NNRTI and bPI initiators, respectively. NNRTI initiators who failed with a pVL ≤500 copies/mL had a 16% higher probability of achieving subsequent suppression at 12 months than bPI initiators (0.81 (25th–75th percentile 0.75–0.83) vs. 0.72 (0.61–0.75)). However, if failing NNRTI initiators had a pVL >500 copies/mL, they had a 20% lower probability of suppressing at 12 months than pVL-matched bPI initiators (0.37 (0.29–0.45) vs. 0.46 (0.38–0.54)). In terms of evolving HIV drug resistance, those who failed on NNRTI performed worse than bPI in all scenarios, especially if they failed with a viral load >500 copies/mL.ConclusionsOur results show that patients who virologically failed at six months on NNRTI and continued on the same regimen had a lower probability of subsequently achieving viral suppression and a higher chance of evolving HIV drug resistance. These results suggest that improving access to regular virologic monitoring is critically important, especially if NNRTI-based cART is to remain a preferred choice for first-line therapy in resource-limited settings.

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Latent Tuberculosis Infection Testing Strategies for HIV-Positive Individuals in Hong Kong

et al. 2019

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Key PointsQuestionIn a setting with low HIV-tuberculosis incidence, is repeated testing for latent tuberculosis infection (LTBI) cost-effective for managing individuals with HIV who have negative LTBI test results at baseline?FindingsIn this decision analytical model using a cost-effectiveness analysis, based on 3130 HIV-positive individuals in Hong Kong, China, a strategy of baseline LTBI testing followed by up to 3 subsequent annual tests could avert a similar proportion of new tuberculosis infections while incurring a lower cost compared with annually repeated testing. The strategy did not meet the willingness-to-pay threshold but would likely be cost-effective if the threshold were raised.MeaningThe findings suggest that less intense subsequent LTBI testing strategies may be effective and are likely cost-effective.

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Tuberculosis in HIV-infected persons in British Columbia during the HAART era

Cited by 6 publications

References 22 publications

A longitudinal study on latent TB infection screening and its association with TB incidence in HIV patients

A longitudinal study on latent TB infection screening and its association with TB incidence in HIV patients

Long‐term effectiveness of initiating non‐nucleoside reverse transcriptase inhibitor‐ versus ritonavir‐boosted protease inhibitor‐based antiretroviral therapy: implications for first‐line therapy choice in resource‐limited settings

Latent Tuberculosis Infection Testing Strategies for HIV-Positive Individuals in Hong Kong

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