Universidad Peruana Cayetano Heredia

Duration of Anti-Tuberculosis Therapy and Timing of Antiretroviral Therapy Initiation: Association with Mortality in HIV-Related Tuberculosis

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dc.contributor.author Cortes, Claudia P.
dc.contributor.author Wehbe, Firas H.
dc.contributor.author McGowan, Catherine C.
dc.contributor.author Shepherd, Bryan E.
dc.contributor.author Duda, Stephany N.
dc.contributor.author Jenkins, Cathy A.
dc.contributor.author González Lagos, Elsa Violeta
dc.contributor.author Carriquiry, Gabriela
dc.contributor.author Schechter, Mauro
dc.contributor.author Padgett, Denis
dc.contributor.author Cesar, Carina
dc.contributor.author Madero, Juan Sierra
dc.contributor.author Pape, JeanW.
dc.contributor.author Masys, D.R.
dc.contributor.author Sterling, T.R.
dc.contributor.author Wolff, M.
dc.contributor.author Arancibia, J.M.
dc.contributor.author Saavedra, F.
dc.contributor.author Salinas, C.
dc.contributor.author Gonzalez, E.
dc.contributor.author Carriquiry, G.
dc.contributor.author Mayer, E.
dc.contributor.author Condorhuaman, P.
dc.contributor.author Gotuzzo Herencia, José Eduardo
dc.contributor.author Schechter, M.
dc.contributor.author Tuboi, S.H.
dc.contributor.author Padgett, D.
dc.contributor.author Cesar, C.
dc.contributor.author Fink, V.
dc.contributor.author Sued, O.
dc.contributor.author Cahn, P.
dc.contributor.author Crabtree, B.
dc.contributor.author Madero, J.S.
dc.contributor.author Bacon, M.
dc.contributor.author Williams, C.
dc.contributor.author Shepherd, B.E.
dc.contributor.author Jenkins, C.A.
dc.contributor.author Duda, S.N.
dc.contributor.author Masys, D.R.
dc.contributor.author McGowan, C.C.
dc.date.accessioned 2022-01-04T20:31:48Z
dc.date.available 2022-01-04T20:31:48Z
dc.date.issued 2013
dc.identifier.uri https://hdl.handle.net/20.500.12866/10673
dc.description.abstract Background: Antiretroviral therapy (ART) decreases mortality risk in HIV-infected tuberculosis patients, but the effect of the duration of anti-tuberculosis therapy and timing of anti-tuberculosis therapy initiation in relation to ART initiation on mortality, is unclear. Methods: We conducted a retrospective observational multi-center cohort study among HIV-infected persons concomitantly treated with Rifamycin-based anti-tuberculosis therapy and ART in Latin America. The study population included persons for whom 6 months of anti-tuberculosis therapy is recommended. Results: Of 253 patients who met inclusion criteria, median CD4+ lymphocyte count at ART initiation was 64 cells/mm3, 171 (68%) received >180 days of anti-tuberculosis therapy, 168 (66%) initiated anti-tuberculosis therapy before ART, and 43 (17%) died. In a multivariate Cox proportional hazards model that adjusted for CD4+ lymphocytes and HIV-1 RNA, tuberculosis diagnosed after ART initiation was associated with an increased risk of death compared to tuberculosis diagnosis before ART initiation (HR 2.40; 95% CI 1.15, 5.02; P = 0.02). In a separate model among patients surviving >6 months after tuberculosis diagnosis, after adjusting for CD4+ lymphocytes, HIV-1 RNA, and timing of ART initiation relative to tuberculosis diagnosis, receipt of >6 months of anti-tuberculosis therapy was associated with a decreased risk of death (HR 0.23; 95% CI 0.08, 0.66; P=0.007). Conclusions: The increased risk of death among persons diagnosed with tuberculosis after ART initiation highlights the importance of screening for tuberculosis before ART initiation. The decreased risk of death among persons receiving > 6 months of anti-tuberculosis therapy suggests that current anti-tuberculosis treatment duration guidelines should be re-evaluated. en_US
dc.language.iso eng
dc.publisher Public Library of Science
dc.relation.ispartofseries PLoS ONE
dc.rights info:eu-repo/semantics/restrictedAccess
dc.rights.uri https://creativecommons.org/licenses/by-nc-nd/4.0/deed.es
dc.subject Tuberculosis en_US
dc.subject Humans en_US
dc.subject major clinical study en_US
dc.subject tuberculosis en_US
dc.subject risk factor en_US
dc.subject Anti-HIV Agents en_US
dc.subject HIV Infections en_US
dc.subject Human immunodeficiency virus infection en_US
dc.subject Time Factors en_US
dc.subject antiretrovirus agent en_US
dc.subject cohort analysis en_US
dc.subject CD4 lymphocyte count en_US
dc.subject risk assessment en_US
dc.subject Retrospective Studies en_US
dc.subject retrospective study en_US
dc.subject article en_US
dc.subject Human immunodeficiency virus 1 en_US
dc.subject risk reduction en_US
dc.subject mortality en_US
dc.subject observational study en_US
dc.subject treatment duration en_US
dc.subject virus RNA en_US
dc.subject Human immunodeficiency virus proteinase inhibitor en_US
dc.subject nonnucleoside reverse transcriptase inhibitor en_US
dc.subject RNA directed DNA polymerase inhibitor en_US
dc.subject efavirenz en_US
dc.subject nevirapine en_US
dc.subject rifamycin en_US
dc.subject survival time en_US
dc.title Duration of Anti-Tuberculosis Therapy and Timing of Antiretroviral Therapy Initiation: Association with Mortality in HIV-Related Tuberculosis en_US
dc.type info:eu-repo/semantics/article
dc.identifier.doi https://doi.org/10.1371/journal.pone.0074057
dc.subject.ocde https://purl.org/pe-repo/ocde/ford#3.03.08
dc.relation.issn 1932-6203


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