Duration of anti-tuberculosis therapy and timing of antiretroviral therapy initiation: association with mortality in HIV-related tuberculosis

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dc.contributor.authorCortes, Claudia
dc.contributor.authorWehbe, Firas H.
dc.contributor.authorMcGowan, Catherine C.
dc.contributor.authorShepherd, Bryan E.
dc.contributor.authorDuda, Stephany N.
dc.contributor.authorJenkins, Cathy A.
dc.contributor.authorGonzalez, Elsa
dc.contributor.authorCarriquiry, Gabriela
dc.contributor.authorSchechter, Mauro
dc.contributor.authorPadgett, Denis
dc.contributor.authorCesar, Carina
dc.contributor.authorSierra Madero, Juan
dc.contributor.authorPape, Jean W.
dc.contributor.authorMasys, Daniel R.
dc.contributor.authorSterling, Timothy R.
dc.contributor.authorSouth American Network for HIV Research (CCASA-net) of the International Epidemiologic Databases to Evaluate AIDS (IeDEA)
dc.date.accessioned2024-05-23T15:24:13Z
dc.date.available2024-05-23T15:24:13Z
dc.date.issued2013
dc.description.abstractBackground 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.
dc.identifier.citationCortes, C. P., Wehbe, F. H., McGowan, C. C., Shepherd, B. E., Duda, S. N., & Jenkins, C. A. (2013). Duration of anti-tuberculosis therapy and timing of antiretroviral therapy initiation: Association with mortality in HIV-related tuberculosis. PLOS ONE, 8(9), e74057. doi:10.1371/journal.pone.0074057.
dc.identifier.other10.1371/journal.pone.0074057
dc.identifier.urihttps://repositorio.huesped.org.ar/handle/123456789/1067
dc.relation.ispartofseriesPLoS ONE, 8(9)
dc.subjectTuberculosis treatment
dc.subjectART initiation timing
dc.subjectHIV mortality
dc.titleDuration of anti-tuberculosis therapy and timing of antiretroviral therapy initiation: association with mortality in HIV-related tuberculosis

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