Khayelitsha, South Africa, with high burdens of
rifampicin-resistant tuberculosis (RR-TB) and HIV co-infection.
To describe time to antiretroviral treatment (ART)
initiation among HIV-infected RR-TB patients initiating RR-TB treatment and to
assess the association between time to ART initiation and treatment outcomes.
A retrospective cohort study of patients with RR-TB and HIV
co-infection not on ART at RR-TB treatment initiation.
Of the 696 RR-TB and HIV-infected patients initiated on
RR-TB treatment between 2009 and 2013, 303 (44%) were not on ART when RR-TB
treatment was initiated. The median CD4 cell count was 126 cells/mm3. Overall 257 (85%)
patients started ART during RR-TB treatment, 33 (11%) within 2 weeks, 152 (50%)
between 2–8 weeks and 72 (24%) after 8 weeks. Of the 46 (15%) who never started
ART, 10 (21%) died or stopped RR-TB treatment within 4 weeks and 16 (37%) had
at least 4 months of RR-TB treatment. Treatment success and mortality during
treatment did not vary by time to ART initiation: treatment success was 41%,
43%, and 50% among patients who started ART within 2 weeks, between 2–8 weeks,
and after 8 weeks (p = 0.62), while mortality was 21%, 13% and 15% respectively
(p = 0.57). Mortality was associated with never receiving ART (adjusted hazard
ratio (aHR) 6.0, CI 2.1–18.1), CD4 count ≤100 (aHR 2.1, CI 1.0–4.5), and
multidrug-resistant tuberculosis (MDR-TB) with second-line resistance (aHR 2.5,
CI 1.1–5.4).
Despite wide variation in time to ART initiation among RR-TB
patients, no differences in mortality or treatment success were observed.
However, a significant proportion of patients did not initiate ART despite
receiving >4 months of RR-TB treatment. Programmatic priorities should focus
on ensuring all patients with RR-TB/HIV co-infection initiate ART regardless of
CD4 count, with special attention for patients with CD4 counts ≤ 100 to
initiate ART as soon as possible after RR-TB treatment initiation.
Below: Kaplan-Meier plot of time to antiretroviral treatment initiation for HIV infected rifampicin resistant tuberculosis patients
Below: Kaplan-Meier plot of survival during treatment of rifampicin resistant tuberculosis by ART initiation, from multivariate Cox regression analysis for HIV co-infected patients
Full article at: http://goo.gl/NjegI5
By:
Johnny Flippie Daniels, Erika Mohr, Vivian Cox, Sizulu Moyo,
Jennifer Hughes, Gilles van Cutsem
Médecins sans Frontières,
Khayelitsha, Cape Town, South Africa
Mohammed Khogali
Médecins sans Frontières,
Luxembourg, Luxembourg
Sizulu Moyo
Human Sciences Research Council,
HIV/AIDS, STIs and TB programme, Cape Town, South Africa
Mary Edginton
International Union against TB
and Lung Disease, Paris, France
Mary Edginton
School of Public Health, Faculty
of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
Sven Gudmund Hinderaker
University of Bergen, Bergen,
Norway
Graeme Meintjes
Institute of Infectious Disease
and Molecular Medicine and Department of Medicine, University of Cape Town,
Cape Town, South Africa
Virginia De Azevedo
City of Cape Town Department of
Health, Cape Town, South Africa
Gilles van Cutsem
Centre for Infectious Disease
Epidemiology and Research, University of Cape Town, Cape Town, South Africa
Helen Suzanne Cox
Division of Medical Microbiology
and Institute of Infectious Disease and Molecular Medicine, University of Cape
Town, Cape Town, South Africa
More at: https://twitter.com/hiv_insight
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