TY - JOUR
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
N1 - Publisher Copyright:
© The Author(s) 2018. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved.
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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U2 - 10.1093/cid/ciy718
DO - 10.1093/cid/ciy718
M3 - Article
C2 - 30137250
AN - SCOPUS:85067600900
SN - 1058-4838
VL - 68
SP - 1739
EP - 1746
JO - Clinical Infectious Diseases
JF - Clinical Infectious Diseases
IS - 10
ER -