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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
Tuberculosis risk factors and mortality for HIV-infected persons receiving antiretroviral therapy in South Africa
AIDS, Volume 24, No. 12, Year 2010
Notification
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Description
Objective: To determine important risk factors for and impact of tuberculosis on survival in HIV-infected patients starting antiretroviral therapy (ART) in South Africa. Design: Prospective trial of 1771 HIV-infected patients with either CD4 cell count less than 200 cells/μl or a prior AIDS-defining illness, enrolled in randomized trial of four antiretroviral regimens. Methods: Data collected from patient records. Results: A history of tuberculosis at study entry was reported by 27% of patients and correlated with poor baseline health status. A history of tuberculosis at baseline was associated with subsequent tuberculosis and death during ART, but was not itself an independent risk factor for poor outcome. Tuberculosis was diagnosed during ART in 14% of patients and was more frequent during the first 3 months. Tuberculosis during therapy was independently associated with increased hazard of other AIDS-defining events and death, regardless of when during ART tuberculosis occurred. ART that consistently suppressed circulating viremia reduced but did not eliminate tuberculosis risk. Conclusion: In HIV-infected patients who started ART at low CD4 cell counts, tuberculosis at baseline was a predictor of death, but was not independent of other factors indicating poor baseline health status. Tuberculosis during follow-up was, in contrast, an independent predictor of death even after adjustments for baseline risk factors, including CD4 cell count and viral load. Virologic failure during ART was associated with a 55% increase in risk of tuberculosis. Thus, tuberculosis is a major marker for poor outcome both at baseline and during ART and is not completely eliminated by fully suppressive ART. © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins.
Authors & Co-Authors
Komati, Stephanus
South Africa, Pretoria
South African National Defence Force
Shaw, Pamela A.
United States, Bethesda
National Institute of Allergy and Infectious Diseases Niaid
Stubbs, Nomso
South Africa, Pretoria
South African National Defence Force
Mathibedi, Monkwe J.
South Africa, Pretoria
South African National Defence Force
Malan, Lizette
South Africa, Pretoria
South African National Defence Force
Sangweni, Phumele
South Africa, Pretoria
South African National Defence Force
Metcalf, Julia A.
United States, Bethesda
National Institute of Allergy and Infectious Diseases Niaid
Masur, Henry
United States, Bethesda
National Institute of Allergy and Infectious Diseases Niaid
Hassim, Shaheen
South Africa, Pretoria
South African National Defence Force
Statistics
Citations: 61
Authors: 9
Affiliations: 2
Identifiers
Doi:
10.1097/QAD.0b013e32833a2507
e-ISSN:
14735571
Research Areas
Environmental
Health System And Policy
Infectious Diseases
Study Design
Cohort Study
Study Locations
South Africa