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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
immunology and microbiology
Initiation of antiretroviral therapy in HIV-infected tuberculosis patients in rural Kenya: An observational study
Tropical Medicine and International Health, Volume 18, No. 7, Year 2013
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Description
Objective: To provide information on the effect of timing of antiretroviral therapy (ART) initiation on outcomes of TB infection in real-life, non-clinical trial, rural settings in sub-Saharan Africa. Methods: We conducted an observational cohort study of all HIV-infected TB patients presenting to a rural hospital in Kenya between 2005 and 2009. We analysed the association between timing of initiation of ART and mortality, using a Cox regression survival analysis, adjusted for measured confounders. Results: A total of 404 antiretroviral-naïve HIV/TB coinfected patients were included in the study. Initiation of ART during the first 8 weeks of TB treatment (early group) was not associated with changes in mortality at 1 year compared with initiation of ART after 8 weeks (late group) [Hazard Ratio (HR) = 0.74 (Confidence Interval (CI), 0.33-1.64, P = 0.46]. In patients with baseline CD4 counts ≤50 cells/μl, there was a significant reduction in mortality in the early group compared with the late group (HR = 0.20; 95% CI, 0.042-0.99; P = 0.049). In patients with a CD4 count >50 cells/μl, there was no significant difference between early and late groups (HR 1.79; 95% CI, 0.64-5.03; P = 0.27). Conclusions: We found that in HIV/TB coinfected patients in rural Kenya, early ART initiation (within 8 weeks) was associated with reduced mortality in those with CD4 counts ≤50 cells/μl. In patients with CD4 counts >50 cells/μl, there was no association seen between timing of ART and mortality. © 2013 Blackwell Publishing Ltd.
Authors & Co-Authors
Stockdale, Alexander J.
United Kingdom, Edinburgh
Western General Hospital
Nkuranga, Joseph
Kenya, Chogoria
Pcea Chogoria Hospital
Török, M. E.
United Kingdom, Cambridge
University of Cambridge
Faragher, Brian E.
United Kingdom, Liverpool
Liverpool School of Tropical Medicine
Lalloo, David G.
United Kingdom, Liverpool
Liverpool School of Tropical Medicine
Statistics
Citations: 9
Authors: 5
Affiliations: 4
Identifiers
Doi:
10.1111/tmi.12110
ISSN:
13602276
e-ISSN:
13653156
Research Areas
Environmental
Health System And Policy
Infectious Diseases
Study Design
Cohort Study
Study Approach
Quantitative
Study Locations
Kenya