Opportunistic diseases diminish the clinical benefit of immediate co-infected antiretroviral adults with therapy low CD4 in HIV-tuberculosis R cell counts

William Worodria, Victor Ssempijja, Colleen Hanrahan, Richard Ssegonja, Abdallah Muhofwa, Doreen Mazapkwe, Harriet Mayanja-Kizza, Steven James Reynolds, Robert Colebunders, Yukari C Manabe

Research output: Contribution to journalArticle

Abstract

Introduction: HIV - tuberculosis (TB) co-infection remains an important cause of mortality in sub-Saharan Africa. Clinical trials have reported early (within 2 weeks of TB therapy) antiretroviral therapy (ART) reduces mortality among HIV - TB co-infected research participants with low CD4 þ cell counts, but this has not been consistently observed. We aimed to evaluate the current WHO recommendations for ART in HIV - TB co-infected patients on mortality in routine clinical settings. Methods: We compared two cohorts before (2008 - 2010) and after (2012 - 2013) policy change on ART timing after TB and examined the effectiveness of early versus delayed ART on mortality in HIV - TB co-infected participants with CD4 þ cell count 100 cells/ml or less. We used inverse probability censoring-weighted Cox models on baseline characteristics to balance the study arms and generated hazard ratios for mortality. Results: Of 356 participants with CD4 þ cell counts 100 cells/ml or less, 180 were in the delayed ART cohorts whereas 176 were in the early ART cohorts. Their median age (32.5 versus 32 years) and baseline CD4 þ cell counts (26.5 versus 26 cells/ml) respectively were similar. There was no difference in mortality rates of both cohorts. The risk of death increased in participants with a positive Cryptococcal antigen (CrAg) test in both the early ART cohort (aHR ¼ 2.6, 95% CI 1.0 - 6.8; P ¼ 0.045) and the delayed ART cohort (aHR ¼ 4.2, 95% CI 1.9 - 9.0; P < 0.001 Conclusion: Early ART in patients with HIV - TB co-infection was not associated with reduced risk of mortality in routine care. Asymptomatic Cryptococcal antigenaemia increased the risk of mortality in both cohorts.

Original languageEnglish (US)
Pages (from-to)2141-2149
Number of pages9
JournalAIDS
Volume32
Issue number15
DOIs
StatePublished - Jan 1 2018

Keywords

  • Adult
  • Antiretroviral therapy
  • HIV
  • Mortality
  • Tuberculosis

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology
  • Infectious Diseases

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