Active Tuberculosis Is Associated with Worse Clinical Outcomes in HIV-Infected African Patients on Antiretroviral Therapy

Abraham M. Siika, Constantin Yiannoutsos, Kara Wools-Kaloustian, Beverly S. Musick, Ann W. Mwangi, Lameck O. Diero, Sylvester N. Kimaiyo, William M. Tierney, Jane E. Carter

Research output: Contribution to journalArticle

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Abstract

Objective: This cohort study utilized data from a large HIV treatment program in western Kenya to describe the impact of active tuberculosis (TB) on clinical outcomes among African patients on antiretroviral therapy (ART). Design: We included all patients initiating ART between March 2004 and November 2007. Clinical (signs and symptoms), radiological (chest radiographs) and laboratory (mycobacterial smears, culture and tissue histology) criteria were used to record the diagnosis of TB disease in the program's electronic medical record system. Methods: We assessed the impact of TB disease on mortality, loss to follow-up (LTFU) and incident AIDS-defining events (ADEs) through Cox models and CD4 cell and weight response to ART by non-linear mixed models. Results: We studied 21,242 patients initiating ART-5,186 (24%) with TB; 62% female; median age 37 years. There were proportionately more men in the active TB (46%) than in the non-TB (35%) group. Adjusting for baseline HIV-disease severity, TB patients were more likely to die (hazard ratio - HR = 1.32, 95% CI 1.18-1.47) or have incident ADEs (HR = 1.31, 95% CI: 1.19-1.45). They had lower median CD4 cell counts (77 versus 109), weight (52.5 versus 55.0 kg) and higher ADE risk at baseline (CD4-adjusted odds ratio = 1.55, 95% CI: 1.31-1.85). ART adherence was similarly good in both groups. Adjusting for gender and baseline CD4 cell count, TB patients experienced virtually identical rise in CD4 counts after ART initiation as those without. However, the overall CD4 count at one year was lower among patients with TB (251 versus 269 cells/μl). Conclusions: Clinically detected TB disease is associated with greater mortality and morbidity despite salutary response to ART. Data suggest that identifying HIV patients co-infected with TB earlier in the HIV-disease trajectory may not fully address TB-related morbidity and mortality.

Original languageEnglish
Article numbere53022
JournalPLoS One
Volume8
Issue number1
DOIs
StatePublished - Jan 2 2013

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tuberculosis
Tuberculosis
HIV
therapeutics
CD4 Lymphocyte Count
Electronic medical equipment
Therapeutics
Histology
Acquired Immunodeficiency Syndrome
Hazards
morbidity
Mortality
Trajectories
Tissue
cells
Morbidity
Weights and Measures
Nonlinear Dynamics
Electronic Health Records
Kenya

ASJC Scopus subject areas

  • Agricultural and Biological Sciences(all)
  • Biochemistry, Genetics and Molecular Biology(all)
  • Medicine(all)

Cite this

Active Tuberculosis Is Associated with Worse Clinical Outcomes in HIV-Infected African Patients on Antiretroviral Therapy. / Siika, Abraham M.; Yiannoutsos, Constantin; Wools-Kaloustian, Kara; Musick, Beverly S.; Mwangi, Ann W.; Diero, Lameck O.; Kimaiyo, Sylvester N.; Tierney, William M.; Carter, Jane E.

In: PLoS One, Vol. 8, No. 1, e53022, 02.01.2013.

Research output: Contribution to journalArticle

Siika, Abraham M. ; Yiannoutsos, Constantin ; Wools-Kaloustian, Kara ; Musick, Beverly S. ; Mwangi, Ann W. ; Diero, Lameck O. ; Kimaiyo, Sylvester N. ; Tierney, William M. ; Carter, Jane E. / Active Tuberculosis Is Associated with Worse Clinical Outcomes in HIV-Infected African Patients on Antiretroviral Therapy. In: PLoS One. 2013 ; Vol. 8, No. 1.
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AU - Musick, Beverly S.

AU - Mwangi, Ann W.

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