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Prognostic significance of the intervals between the initiation of antiretroviral therapy and anti-tuberculosis treatment in HIV-tuberculosis co-infected patients: Results from the TREAT Asia HIV Observational Database

Authors
 SH Han  ;  J Zhou  ;  MP Lee  ;  H Zhao  ;  Y-MA Chen  ;  N Kumarasamy  ;  S Pujari  ;  C Lee  ;  SFS Omar  ;  R Ditangco  ;  N Phanuphak  ;  S Kiertiburanakul  ;  R Chaiwarith  ;  TP Merati  ;  E Yunihastuti  ;  J Tanuma  ;  V Saphonn  ;  AH Sohn  ;  JY Choi 
Citation
 HIV MEDICINE, Vol.15(2) : 77-85, 2014 
Journal Title
 HIV MEDICINE 
ISSN
 1464-2662 
Issue Date
2014
MeSH
AIDS-Related Opportunistic Infections/drug therapy* ; Adult ; Antirheumatic Agents/therapeutic use* ; Antitubercular Agents/therapeutic use* ; Asia ; Coinfection/drug therapy ; Coinfection/virology ; Female ; HIV Infections/complications ; HIV Infections/drug therapy* ; HIV Infections/virology ; Humans ; Male ; Middle Aged ; Prognosis ; Proportional Hazards Models ; Prospective Studies ; Survival Analysis ; Time Factors ; Tuberculosis/complications ; Tuberculosis/drug therapy* ; Viral Load
Keywords
HIV ; antiretroviral therapy ; antitubercular agents ; tuberculosis
Abstract
Objectives : We evaluated the effect of the time interval between the initiation of antiretroviral therapy (ART) and the initiation of tuberculosis (TB) treatment on clinical outcomes in HIV/TB-coinfected patients in an Asian regional cohort. Methods : Adult HIV/TB-coinfected patients in an observational HIV-infected cohort database who had a known date of ART initiation and a history of TB treatment were eligible for study inclusion. The time interval between the initiation of ART and the initiation of TB treatment was categorized as follows: TB diagnosed while on ART, ART initiated ≤ 90 days after initiation of TB treatment (‘early ART’), ART initiated > 90 days after initiation of TB treatment (‘delayed ART’), and ART not started. Outcomes were assessed using survival analyses. Results : A total of 768 HIV/TB-coinfected patients were included in this study. The median CD4 T-cell count at TB diagnosis was 100 [interquartile range (IQR) 40-208] cells/μL. Treatment outcomes were not significantly different between the groups with early ART and delayed ART initiation. Kaplan−Meier analysis indicated that mortality was highest for those diagnosed with TB while on ART (3.77 deaths per 100 person-years), and the prognoses of other groups were not different (in deaths per 100 person-years: 2.12 for early ART, 1.46 for delayed ART, and 2.94 for ART not started). In a multivariate model, the interval between ART initiation and TB therapy initiation did not significantly impact all-cause mortality. Conclusions : A negative impact of delayed ART in patients coinfected with TB was not observed in this observational cohort of moderately to severely immunosuppressed patients. The broader impact of earlier ART initiation in actual clinical practice should be monitored more closely.
Full Text
http://onlinelibrary.wiley.com/doi/10.1111/hiv.12073/abstract
DOI
10.1111/hiv.12073
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Choi, Jun Yong(최준용) ORCID logo https://orcid.org/0000-0002-2775-3315
Han, Sang Hoon(한상훈) ORCID logo https://orcid.org/0000-0002-4278-5198
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/97997
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