Human Immunodeficiency Virus Type 1 and Tuberculosis Coinfection in Multinational, Resource-limited Settings: Increased neurological dysfunction

5199 Study Team; for the AIDS Clinical Trials Group

Research output: Contribution to journalArticle

Abstract

Background. AIDS Clinical Trial Group 5199 compared neurological and neuropsychological test performance of human immunodeficiency virus type 1 (HIV-1)-infected participants in resource-limited settings treated with 3 World Health Organization-recommended antiretroviral (ART) regimens. We investigated the impact of tuberculosis (TB) on neurological and neuropsychological outcomes. Methods. Standardized neurological and neuropsychological examinations were administered every 24 weeks. Generalized estimating equation models assessed the association between TB and neurological/neuropsychological performance. Results. Characteristics of the 860 participants at baseline were as follows: 53% female, 49% African; median age, 34 years; CD4 count, 173 cells/μL; and plasma HIV-1 RNA, 5.0 log copies/mL. At baseline, there were 36 cases of pulmonary, 9 cases of extrapulmonary, and 1 case of central nervous system (CNS) TB. Over the 192 weeks of follow-up, there were 55 observations of pulmonary TB in 52 persons, 26 observations of extrapulmonary TB in 25 persons, and 3 observations of CNS TB in 2 persons. Prevalence of TB decreased with ART initiation and follow-up. Those with TB coinfection had significantly poorer performance on grooved pegboard (P < .001) and fingertapping nondominant hand (P < .01). TB was associated with diffuse CNS disease (P < .05). Furthermore, those with TB had 9.27 times (P < .001) higher odds of reporting decreased quality of life, and had 8.02 times (P = .0005) higher odds of loss of productivity. Conclusions. TB coinfection was associated with poorer neuropsychological functioning, particularly the fine motor skills, and had a substantial impact on functional ability and quality of life.

Original languageEnglish (US)
Pages (from-to)1739-1746
Number of pages8
JournalClinical Infectious Diseases
Volume68
Issue number10
DOIs
StatePublished - May 1 2019

Fingerprint

Coinfection
HIV-1
Tuberculosis
Central Nervous System Tuberculosis
Quality of Life
Motor Skills
Aptitude
Neuropsychological Tests
Central Nervous System Diseases
Neurologic Examination
CD4 Lymphocyte Count
Pulmonary Tuberculosis
Acquired Immunodeficiency Syndrome
Hand
Clinical Trials
RNA
Efficiency
Lung

Keywords

  • Cognitive impairment
  • HIV
  • Neuropsychological functioning
  • Resource-limited
  • Tuberculosis

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases

Cite this

Human Immunodeficiency Virus Type 1 and Tuberculosis Coinfection in Multinational, Resource-limited Settings : Increased neurological dysfunction. / 5199 Study Team; for the AIDS Clinical Trials Group.

In: Clinical Infectious Diseases, Vol. 68, No. 10, 01.05.2019, p. 1739-1746.

Research output: Contribution to journalArticle

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title = "Human Immunodeficiency Virus Type 1 and Tuberculosis Coinfection in Multinational, Resource-limited Settings: Increased neurological dysfunction",
abstract = "Background. AIDS Clinical Trial Group 5199 compared neurological and neuropsychological test performance of human immunodeficiency virus type 1 (HIV-1)-infected participants in resource-limited settings treated with 3 World Health Organization-recommended antiretroviral (ART) regimens. We investigated the impact of tuberculosis (TB) on neurological and neuropsychological outcomes. Methods. Standardized neurological and neuropsychological examinations were administered every 24 weeks. Generalized estimating equation models assessed the association between TB and neurological/neuropsychological performance. Results. Characteristics of the 860 participants at baseline were as follows: 53{\%} female, 49{\%} African; median age, 34 years; CD4 count, 173 cells/μL; and plasma HIV-1 RNA, 5.0 log copies/mL. At baseline, there were 36 cases of pulmonary, 9 cases of extrapulmonary, and 1 case of central nervous system (CNS) TB. Over the 192 weeks of follow-up, there were 55 observations of pulmonary TB in 52 persons, 26 observations of extrapulmonary TB in 25 persons, and 3 observations of CNS TB in 2 persons. Prevalence of TB decreased with ART initiation and follow-up. Those with TB coinfection had significantly poorer performance on grooved pegboard (P < .001) and fingertapping nondominant hand (P < .01). TB was associated with diffuse CNS disease (P < .05). Furthermore, those with TB had 9.27 times (P < .001) higher odds of reporting decreased quality of life, and had 8.02 times (P = .0005) higher odds of loss of productivity. Conclusions. TB coinfection was associated with poorer neuropsychological functioning, particularly the fine motor skills, and had a substantial impact on functional ability and quality of life.",
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author = "{5199 Study Team; for the AIDS Clinical Trials Group} and Robertson, {Kevin R.} and Bibilola Oladeji and Hongyu Jiang and Johnstone Kumwenda and Khuanchai Supparatpinyo and Campbell, {Thomas B.} and James Hakim and Srikanth Tripathy and Hosseinipour, {Mina C.} and Marra, {Christina M.} and Nagalingeswaran Kumarasamy and Scott Evans and Alyssa Vecchio and Rosa, {Alberto La} and Breno Santos and Silva, {Marcus T.} and Sylvia Montano and Cecilia Kanyama and Cindy Firnhaber and Richard Price and Cheryl Marcus and Baida Berzins and Reena Masih and Umesh Lalloo and Ian Sanne and Sarah Yosief and Ann Walawander and Aspara Nair and Ned Sacktor and Colin Hall",
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T1 - Human Immunodeficiency Virus Type 1 and Tuberculosis Coinfection in Multinational, Resource-limited Settings

T2 - Increased neurological dysfunction

AU - 5199 Study Team; for the AIDS Clinical Trials Group

AU - Robertson, Kevin R.

AU - Oladeji, Bibilola

AU - Jiang, Hongyu

AU - Kumwenda, Johnstone

AU - Supparatpinyo, Khuanchai

AU - Campbell, Thomas B.

AU - Hakim, James

AU - Tripathy, Srikanth

AU - Hosseinipour, Mina C.

AU - Marra, Christina M.

AU - Kumarasamy, Nagalingeswaran

AU - Evans, Scott

AU - Vecchio, Alyssa

AU - Rosa, Alberto La

AU - Santos, Breno

AU - Silva, Marcus T.

AU - Montano, Sylvia

AU - Kanyama, Cecilia

AU - Firnhaber, Cindy

AU - Price, Richard

AU - Marcus, Cheryl

AU - Berzins, Baida

AU - Masih, Reena

AU - Lalloo, Umesh

AU - Sanne, Ian

AU - Yosief, Sarah

AU - Walawander, Ann

AU - Nair, Aspara

AU - Sacktor, Ned

AU - Hall, Colin

PY - 2019/5/1

Y1 - 2019/5/1

N2 - Background. AIDS Clinical Trial Group 5199 compared neurological and neuropsychological test performance of human immunodeficiency virus type 1 (HIV-1)-infected participants in resource-limited settings treated with 3 World Health Organization-recommended antiretroviral (ART) regimens. We investigated the impact of tuberculosis (TB) on neurological and neuropsychological outcomes. Methods. Standardized neurological and neuropsychological examinations were administered every 24 weeks. Generalized estimating equation models assessed the association between TB and neurological/neuropsychological performance. Results. Characteristics of the 860 participants at baseline were as follows: 53% female, 49% African; median age, 34 years; CD4 count, 173 cells/μL; and plasma HIV-1 RNA, 5.0 log copies/mL. At baseline, there were 36 cases of pulmonary, 9 cases of extrapulmonary, and 1 case of central nervous system (CNS) TB. Over the 192 weeks of follow-up, there were 55 observations of pulmonary TB in 52 persons, 26 observations of extrapulmonary TB in 25 persons, and 3 observations of CNS TB in 2 persons. Prevalence of TB decreased with ART initiation and follow-up. Those with TB coinfection had significantly poorer performance on grooved pegboard (P < .001) and fingertapping nondominant hand (P < .01). TB was associated with diffuse CNS disease (P < .05). Furthermore, those with TB had 9.27 times (P < .001) higher odds of reporting decreased quality of life, and had 8.02 times (P = .0005) higher odds of loss of productivity. Conclusions. TB coinfection was associated with poorer neuropsychological functioning, particularly the fine motor skills, and had a substantial impact on functional ability and quality of life.

AB - Background. AIDS Clinical Trial Group 5199 compared neurological and neuropsychological test performance of human immunodeficiency virus type 1 (HIV-1)-infected participants in resource-limited settings treated with 3 World Health Organization-recommended antiretroviral (ART) regimens. We investigated the impact of tuberculosis (TB) on neurological and neuropsychological outcomes. Methods. Standardized neurological and neuropsychological examinations were administered every 24 weeks. Generalized estimating equation models assessed the association between TB and neurological/neuropsychological performance. Results. Characteristics of the 860 participants at baseline were as follows: 53% female, 49% African; median age, 34 years; CD4 count, 173 cells/μL; and plasma HIV-1 RNA, 5.0 log copies/mL. At baseline, there were 36 cases of pulmonary, 9 cases of extrapulmonary, and 1 case of central nervous system (CNS) TB. Over the 192 weeks of follow-up, there were 55 observations of pulmonary TB in 52 persons, 26 observations of extrapulmonary TB in 25 persons, and 3 observations of CNS TB in 2 persons. Prevalence of TB decreased with ART initiation and follow-up. Those with TB coinfection had significantly poorer performance on grooved pegboard (P < .001) and fingertapping nondominant hand (P < .01). TB was associated with diffuse CNS disease (P < .05). Furthermore, those with TB had 9.27 times (P < .001) higher odds of reporting decreased quality of life, and had 8.02 times (P = .0005) higher odds of loss of productivity. Conclusions. TB coinfection was associated with poorer neuropsychological functioning, particularly the fine motor skills, and had a substantial impact on functional ability and quality of life.

KW - Cognitive impairment

KW - HIV

KW - Neuropsychological functioning

KW - Resource-limited

KW - Tuberculosis

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