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Título:
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HIV-related tuberculosis: Mortality risk in persons without vs With culture-confirmed disease
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Autores:
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Crabtree-Ramírez, B. ;
Jenkins, C. ;
Jayathilake, K. ;
Carriquiry, G. ;
Veloso, V. ;
Padgett, D. ;
Gotuzzo, E. ;
Cortes, C. ;
Mejia, F. ;
McGowan, C.C. ;
Duda, S. ;
Shepherd, B.E. ;
Sterling, T.R.
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Tipo de documento:
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texto impreso
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Editorial:
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International Union Against Tuberculosis and Lung Disease, 2019-07-04T17:00:15Z
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Nota general:
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info:eu-repo/semantics/restrictedAccess
https://creativecommons.org/licenses/by-nc-nd/4.0/deed.es
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Idiomas:
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Inglés
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Palabras clave:
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Editados por otras instituciones
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Artículos
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Artículos en revistas indizadas
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Resumen:
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BACKGROUND: Tuberculosis (TB) diagnosis in human immunodeficiency virus (HIV) positive persons is difficult, particularly in resource-limited settings. The relationship between TB culture status and mortality in HIV-positive persons treated for TB is unclear. METHODS : We evaluated HIV-positive adults treated for TB at or after their first HIV clinic visit in Argentina, Brazil, Chile, Honduras, Mexico or Peru from 2000 to 2015. Anti-tuberculosis treatment included 2 months of isoniazid, rifampicin (RMP)/rifabutin (RBT), pyrazinamide 6 ethambutol, followed by continuation phase treatment with isoniazid + RMP/RBT. RESULTS : Of 759 TB-HIV patients, 238 (31%) were culture-negative, 228 (30%) had unknown culture status or did not undergo culture and 293 (39%) were culturepositive. The median CD4 at TB diagnosis was 96 (interquartile range 40-228); 636 (84%) received concurrent antiretroviral therapy (ART) and antituberculosis treatment. There were 123 (16%) deaths: 90/466 (19%) with TB culture-negative, unknown or not performed vs. 33/293 (11%) who were TB culturepositive (P=0.005). In Kaplan-Meier analysis, mortality in TB patients without culture-confirmed disease was higher (P=0.002). In a Cox model adjusted for age, sex, CD4, ART timing, disease site and stratified by study site, mortality in persons without culture-confirmed TB was not significantly increased compared to those with culture-positive TB (hazard ratio 1.39, 95%CI 0.89- 2.16, P = 0.15). CONCLUSION: Most HIV-positive patients treated for TB did not have culture-confirmed TB, and mortality tended to be higher in patients without culture-confirmed disease, although the association was not statistically different after adjusting for other variables. Accurate TB diagnosis in HIV-positive persons is crucial. © 2019 The Union.
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En línea:
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http://doi.org/10.5588/ijtld.18.0111
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