Treatment outcomes of tuberculosis in HIV-infected patients after initiation of anti-retroviral therapy in a resource-limited setting
Abstract number: P1566
Manosuthi W., Tansuphaswadikul S., Mankatitham W., Lueangniyomkul A., Chimsuntorn S., Sungkanuparph S.
Objectives: To study the clinical outcome of tuberculosis (TB) treatment after initiation of ART in a resource-limited setting with high TB burden.
Methods: A retrospective cohort study was conducted in co-infected HIV and TB patients who had received anti-TB regimen and were subsequently initiated ART between January 2004 and December 2005. TB was diagnosed by clinical features, positive acid fast stain, and/or positive culture. Outcome of TB treatment was assessed after 48 weeks of ART.
Results: There were 188 patients with a mean (±SD) age of 36 (± 8) years; 68% were males. The mean (±SD) body weight was 53.3 ± 8.5 kgs. Median (IQR) CD4 cell count and plasma HIV-1 RNA at the time of TB diagnosis were 36 (1577) cells/mm3 and 5.6 (5.25.9) log copies/mL, respectively. Of all, 111 (59.0%) patients received nevirapine-based ART and the others received efavirenz-based ART. Median (IQR) duration from TB treatment to ART initiation was 1.7 (1.23.3) months. At 48 weeks, 144 (76.6%), 21 (11.2%), 11 (5.8%), 7 (3.7%) and 5 (2.7%) patients were cure/completed treatment, lost to follow-up, transferred care, died and receiving TB treatment (recurrent or drug resistant). Four of 7 (57.1%) causes of death were related to TB and one of these was related to TB immune reconstitution inflammatory syndrome (IRIS). After 48 weeks of ART, median (IQR) CD4 cell count was 232 (166347) cells/mm3 and mean (±SD) body weight was 61.1 (±11.1) kgs; both were significantly different when compared to baseline values (P < 0.05). By multivariate analysis, patients who received efavirenz-based ART had a higher tendency of cure/completed treatment of TB than those who received nevirapine-based ART after adjusting for age, baseline CD4 cell, baseline body weight, site of TB and timing from TB diagnosis to ART initiation (P = 0.057, OR=2.179, 95% CI=0.9774.878).
Conclusions: Treatment outcome of TB among co-infected HIV and TB patients who subsequently receive ART is favorable. Recurrent or drug resistance rate is less than 3%. The further collaboration between HIV and TB program will lead to both successful scaling up of ART and effective treatment of TB among co-infected HIV and TB patients in the resource-limited settings.
|Session name:||18th European Congress of Clinical Microbiology and Infectious Diseases|
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