Work

Antiretroviral therapy improves survival among TB-HIV co-infected patients who have CD4+ T-cell count above 350cells/mm3

Year: 2016

Type: article

Abstract: Co-infection with Mycobacterium tuberculosis remains a leading cause of morbidity and mortality among HIV infected individuals especially in developing countries. Early initiation of cART in these patients when CD4+ T cell count is less than 200cells/mm 3 has reduced disease progression and mortality. However for patients with higher CD4+ T cell counts greater than 350cells/mm 3 evidence is conflicting. In this study we seek to evaluate the effectiveness of cART in reducing mortality among TB-HIV co-infected patients with CD4 + T cells above 350cells/mm 3 at the time of TB diagnosis. In a retrospective cohort study we analyzed 337 HIV-TB co-infected patients with CD4+ T cells above 350cells/mm 3 at baseline who were diagnosed between 2006 and 2012 in the southern province of Zambia. The primary outcome was all-cause mortality. We estimated the effect of cART by comparing survival according to cART and controlling for differential loss to follow-up. Of the 257 patients on cART, 22 died (9 %) and 20 (8 %) were lost to follow-up; of 80 patients not on cART, 20 died (25 %) and 19 (24 %) were lost to follow-up. Patients treated with cART had better survival compared to those not treated ( P < 0 · 0001, log-rank test). In a proportional hazard regression adjusting for Cotrimoxazole, the risk of death was reduced by 78 % with cART (95 % CI: 0 · 47, 0 · 91). In a propensity score analysis, the effect of cART was still beneficial. In patients with HIV-associated TB and CD4+ T cells above 350cells/mm 3 , treatment with cART reduced mortality for up to 4 years as compared to no cART and was associated with better retention in care.

Source: BMC Infectious Diseases

DOI: 10.1186/s12879-016-1916-1

Authors: Simon Mutembo, Jane N. Mutanga, Kebby Musokotwane, Lutangu Alisheke, Christopher C. Whalen

Institutions: Ministry of Health, University of Georgia

Language: English

Topic: HIV/AIDS Research and Interventions

Subfield: Infectious Diseases

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $3,090