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HIV-related tuberculosis: Mortality risk in persons without vs With culture-confirmed disease

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dc.contributor.author Crabtree-Ramírez, B.
dc.contributor.author Jenkins, C.
dc.contributor.author Jayathilake, K.
dc.contributor.author Carriquiry, G.
dc.contributor.author Veloso, V.
dc.contributor.author Padgett, D.
dc.contributor.author Gotuzzo, E.
dc.contributor.author Cortes, C.
dc.contributor.author Mejia, F.
dc.contributor.author McGowan, C.C.
dc.contributor.author Duda, S.
dc.contributor.author Shepherd, B.E.
dc.contributor.author Sterling, T.R.
dc.date.accessioned 2019-12-06T20:57:49Z
dc.date.available 2019-12-06T20:57:49Z
dc.date.issued 2019
dc.identifier.uri https://hdl.handle.net/20.500.12866/7436
dc.description.abstract 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. en_US
dc.language.iso eng
dc.publisher International Union Against Tuberculosis and Lung Disease
dc.relation.ispartof urn:issn:1815-7920
dc.rights info:eu-repo/semantics/restrictedAccess
dc.rights.uri https://creativecommons.org/licenses/by-nc-nd/4.0/deed.es
dc.subject adult en_US
dc.subject age distribution en_US
dc.subject Anti-tuberculosis treatment en_US
dc.subject Argentina en_US
dc.subject Article en_US
dc.subject bacterial growth en_US
dc.subject bacterium culture en_US
dc.subject CD4 lymphocyte count en_US
dc.subject Chile en_US
dc.subject cohort analysis en_US
dc.subject controlled study en_US
dc.subject Culture-negative tuberculosis en_US
dc.subject disease association en_US
dc.subject ethambutol en_US
dc.subject female en_US
dc.subject genetic heterogeneity en_US
dc.subject Honduras en_US
dc.subject human en_US
dc.subject Human immunodeficiency virus and TB en_US
dc.subject Human immunodeficiency virus infection en_US
dc.subject isoniazid en_US
dc.subject Latin America en_US
dc.subject log rank test en_US
dc.subject major clinical study en_US
dc.subject male en_US
dc.subject Mexico en_US
dc.subject mortality en_US
dc.subject Peru en_US
dc.subject priority journal en_US
dc.subject probability en_US
dc.subject pyrazinamide en_US
dc.subject rifabutin en_US
dc.subject rifampicin en_US
dc.subject risk assessment en_US
dc.subject tuberculosis en_US
dc.subject World Health Organization en_US
dc.title HIV-related tuberculosis: Mortality risk in persons without vs With culture-confirmed disease en_US
dc.type info:eu-repo/semantics/article
dc.identifier.doi https://doi.org/10.5588/ijtld.18.0111
dc.subject.ocde https://purl.org/pe-repo/ocde/ford#3.02.00 es_PE


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