Opportunistic diseases diminish the clinical benefit of immediate antiretroviral therapy in HIV–tuberculosis co-infected adults with low CD4+ cell counts. (24th September 2018)

• Record Type: Journal Article
• Authors: Worodria, William; Ssempijja, Victor; Hanrahan, Coleen; Ssegonja, Richard; Muhofwa, Abdallah; Mazapkwe, Doreen; Mayanja-Kizza, Harriet; Reynolds, Steven J.; Colebunders, Robert; Manabe, Yukari C.
• Is Part Of: AIDS. Volume 32:Number 15(2018)
• Publication Date: 2018-09-24
• Subjects: adult -- antiretroviral therapy -- HIV -- mortality -- tuberculosis; AIDS (Disease) -- Periodicals; Acquired Immunodeficiency Syndrome; AIDS (Disease); Periodicals; Periodicals; 616.9792005
• DOI: 10.1097/QAD.0000000000001941
• Languages: English
• ISSNs: 0269-9370

Abstract

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 + 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 + cell count 100 cells/μl 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 + cell counts 100 cells/μl 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 + cell counts (26.5 versus 26 cells/μl) 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 = 2.6, 95% CI 1.0–6.8; P = 0.045) and the delayed ART cohort (aHR = 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. Abstract : Supplemental Digital Content is available in the text