TY - JOUR
T1 - Antiretroviral treatment-associated tuberculosis in a prospective cohort of HIV-infected patients starting ART
AU - Worodria, William
AU - Massinga-Loembe, Marguerite
AU - Mayanja-Kizza, Harriet
AU - Namaganda, Jane
AU - Kambugu, Andrew
AU - Manabe, Yukari C.
AU - Kestens, Luc
AU - Colebunders, Robert
PY - 2011
Y1 - 2011
N2 - Commencement of antiretroviral treatment (ART) in severely immunosuppressed HIV-infected persons is associated with unmasking of subclinical disease. The subset of patients that are diagnosed with tuberculosis (TB) disease while on ART have been classified as ART-associated TB. Few studies have reported the incidence of ART-associated TB and unmasking TB-IRIS according to the International Network for the Study of HIV-Associated IRIS (INSHI) consensus definition. To determine the incidence and predictors of ART-associated TB, we screened 219 patients commencing ART at the Infectious Diseases Clinic in Kampala, Uganda for TB by symptoms, sputum microscopy, and chest X-rays and followed them for one year. Fourteen (6.4%) patients were diagnosed with TB during followup. Eight (3.8%) patients had ART-associated TB (incidence rate of 4.3 per 100 person years); of these, three patients fulfilled INSHI criteria for unmasking TB-associated IRIS (incidence rate of 1.6 per 100 person years). A body mass index of less than 18.5kg/m2 BMI (HR 5.85 95% CI 1.24-27.46, P =.025) and a C-reactive protein greater than 5mg/L (HR 8.23 95% CI 1.36-38.33, P =.020) were risk factors for ART-associated TB at multivariate analysis. In conclusion, with systematic TB screening (including culture and chest X-ray), the incidence of ART-associated TB is relatively low in settings with high HIV and TB prevalence.
AB - Commencement of antiretroviral treatment (ART) in severely immunosuppressed HIV-infected persons is associated with unmasking of subclinical disease. The subset of patients that are diagnosed with tuberculosis (TB) disease while on ART have been classified as ART-associated TB. Few studies have reported the incidence of ART-associated TB and unmasking TB-IRIS according to the International Network for the Study of HIV-Associated IRIS (INSHI) consensus definition. To determine the incidence and predictors of ART-associated TB, we screened 219 patients commencing ART at the Infectious Diseases Clinic in Kampala, Uganda for TB by symptoms, sputum microscopy, and chest X-rays and followed them for one year. Fourteen (6.4%) patients were diagnosed with TB during followup. Eight (3.8%) patients had ART-associated TB (incidence rate of 4.3 per 100 person years); of these, three patients fulfilled INSHI criteria for unmasking TB-associated IRIS (incidence rate of 1.6 per 100 person years). A body mass index of less than 18.5kg/m2 BMI (HR 5.85 95% CI 1.24-27.46, P =.025) and a C-reactive protein greater than 5mg/L (HR 8.23 95% CI 1.36-38.33, P =.020) were risk factors for ART-associated TB at multivariate analysis. In conclusion, with systematic TB screening (including culture and chest X-ray), the incidence of ART-associated TB is relatively low in settings with high HIV and TB prevalence.
UR - http://www.scopus.com/inward/record.url?scp=79251582478&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=79251582478&partnerID=8YFLogxK
U2 - 10.1155/2011/758350
DO - 10.1155/2011/758350
M3 - Article
C2 - 21197091
AN - SCOPUS:79251582478
SN - 1740-2522
VL - 2011
JO - Clinical and Developmental Immunology
JF - Clinical and Developmental Immunology
M1 - 758350
ER -