Duration of Anti-Tuberculosis Therapy and Timing of Antiretroviral Therapy Initiation: Association with Mortality in HIV-Related Tuberculosis
Author
dc.contributor.author
Cortés Moncada, Claudia
Author
dc.contributor.author
Wehbe, Firas H.
es_CL
Author
dc.contributor.author
McGowan, Catherine C.
es_CL
Author
dc.contributor.author
Shepherd, Bryan E.
es_CL
Author
dc.contributor.author
Duda, Stephany N.
es_CL
Author
dc.contributor.author
Jenkins, Cathy A.
es_CL
Author
dc.contributor.author
González, Elsa
es_CL
Author
dc.contributor.author
Carriquiry, Gabriela
es_CL
Author
dc.contributor.author
Schechter, Mauro
es_CL
Author
dc.contributor.author
Padgett, Denis
es_CL
Author
dc.contributor.author
César, Carina
es_CL
Author
dc.contributor.author
Sierra Madero, Juan
es_CL
Author
dc.contributor.author
Pape, Jean W.
es_CL
Author
dc.contributor.author
Masys, Daniel R.
es_CL
Author
dc.contributor.author
Sterling, Timothy R.
es_CL
Admission date
dc.date.accessioned
2014-01-14T15:28:22Z
Available date
dc.date.available
2014-01-14T15:28:22Z
Publication date
dc.date.issued
2013
Cita de ítem
dc.identifier.citation
PLoS ONE 8(9): e74057
en_US
Identifier
dc.identifier.other
doi:10.1371/journal.pone.0074057
Identifier
dc.identifier.uri
https://repositorio.uchile.cl/handle/2250/129147
General note
dc.description
Artículo de publicación ISI
en_US
Abstract
dc.description.abstract
Background: Antiretroviral therapy (ART) decreases mortality risk in HIV-infected tuberculosis patients, but the
effect of the duration of anti-tuberculosis therapy and timing of anti-tuberculosis therapy initiation in relation to ART
initiation on mortality, is unclear.
Methods: We conducted a retrospective observational multi-center cohort study among HIV-infected persons
concomitantly treated with Rifamycin-based anti-tuberculosis therapy and ART in Latin America. The study
population included persons for whom 6 months of anti-tuberculosis therapy is recommended.
Results: Of 253 patients who met inclusion criteria, median CD4+ lymphocyte count at ART initiation was 64
cells/mm3, 171 (68%) received >180 days of anti-tuberculosis therapy, 168 (66%) initiated anti-tuberculosis therapy
before ART, and 43 (17%) died. In a multivariate Cox proportional hazards model that adjusted for CD4+
lymphocytes and HIV-1 RNA, tuberculosis diagnosed after ART initiation was associated with an increased risk of
death compared to tuberculosis diagnosis before ART initiation (HR 2.40; 95% CI 1.15, 5.02; P = 0.02). In a separate
model among patients surviving >6 months after tuberculosis diagnosis, after adjusting for CD4+ lymphocytes, HIV-1
RNA, and timing of ART initiation relative to tuberculosis diagnosis, receipt of >6 months of anti-tuberculosis therapy
was associated with a decreased risk of death (HR 0.23; 95% CI 0.08, 0.66; P=0.007).
Conclusions: The increased risk of death among persons diagnosed with tuberculosis after ART initiation highlights
the importance of screening for tuberculosis before ART initiation. The decreased risk of death among persons
receiving > 6 months of anti-tuberculosis therapy suggests that current anti-tuberculosis treatment duration
guidelines should be re-evaluated.