All-cause mortality 37% higher with TB in Ugandans starting ART
Having pulmonary tuberculosis raised the risk of all-cause mortality 37% in Ugandan adults starting ART in a prospectively studied cohort of 22,477 people.
Although it is well known that TB affects survival of people
coinfected with HIV, the magnitude of that impact is not well
understood. To address that question, researchers conducted
this study of 22,477 adults who began ART between August 2000
and June 2009 in Uganda. They determined who had pulmonary TB
when they began ART and figured how many people died during
follow-up. The investigators used a method called
propensity-score matching to
account
for variables that might affect death in people with or
without TB.
Of the 22,477 cohort members, 7.5% had active pulmonary TB
when they began ART. People with TB were more likely to be
men, have an AIDS-defining illness, have World Health
Organization (WHO) stage 3 or 4 disease, and have a lower
pre-ART CD4 count (P < 0.001). During follow-up
10.47% of people with TB and 6.38% without TB died.
The crude estimate of death indicated that people with TB when
they began ART had almost a 75% higher risk of death (hazard
ratio [HR] 1.74, 95% confidence interval [CI] 1.49 to 2.04).
Among 1686 propensity score-matched pairs with and without TB,
the risk of all-cause mortality was 37% higher in the TB group
(HR 1.37, 95% CI 1.08 to 1.75).
The authors believe this is the largest cohort of HIV-positive
people taking ART in a single African country that has been
evaluated for mortality in people coinfected with TB. They
note that their findings are complementary to results of the
recent SAPIT, CAMELIA, and STRIDE trials, which found that
earlier ART in people being treated for TB improves
survival.
The investigators conclude that their results “validate
the WHO guidelines that urge a more aggressive approach to
management of both TB and HIV.”
Source:
Rong Chu, Edward J. Mills, Joseph Beyene, Eleanor
Pullenayegum, Celestin Bakanda, Jean B. Nachega, P.J.
Devereaux, Lehana Thabane. Impact of tuberculosis on mortality
among HIV-infected patients receiving antiretroviral therapy
in Uganda: a prospective cohort analysis.
AIDS Research and Therapy. 2013; 10: 19.
Complete article provided by AIDS Research and Therapy, an open-access journal
Source:
IAS
