Duration of Anti-Tuberculosis Therapy and Timing of Antiretroviral Therapy Initiation

Association with Mortality in HIV-Related Tuberculosis

Claudia P. Cortes, Firas H. Wehbe, Catherine C. McGowan, Bryan E. Shepherd, Stephany N. Duda, Cathy A. Jenkins, Elsa Gonzalez, Gabriela Carriquiry, Mauro Schechter, Denis Padgett, Carina Cesar, Juan Sierra Madero, Jean W. Pape, Daniel R. Masys, Timothy R. Sterling*, Claudia P. Cortes, Marcello Wolff, José Miguel Arancibia, Felipe Saavedra, Carolina Salinas & 22 others Elsa Gonzalez, Gabriela Carriquiry, Erick Mayer, Patricia Condorhuaman, Eduardo Gotuzzo, Mauro Schechter, Suely H. Tuboi, Denis Padgett, Carina Cesar, Valeria Fink, Omar Sued, Pedro Cahn, Brenda Crabtree, Juan Sierra Madero, Melanie Bacon, Carolyn Williams, Firas H. Wehbe, Bryan E. Shepherd, Cathy A. Jenkins, Stephany N. Duda, Daniel R. Masys, Catherine C. McGowan

*Corresponding author for this work

Research output: Contribution to journalArticle

3 Citations (Scopus)

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/mm 3 , 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.

Original languageEnglish (US)
Article numbere74057
JournalPloS one
Volume8
Issue number9
DOIs
StatePublished - Sep 16 2013

Fingerprint

tuberculosis
Tuberculosis
HIV
Lymphocytes
therapeutics
duration
Mortality
RNA
Therapeutics
Hazards
Screening
death
risk reduction
Human immunodeficiency virus 1
HIV-1
rifamycins
lymphocytes
lymphocyte count
Latin America
cohort studies

ASJC Scopus subject areas

  • Biochemistry, Genetics and Molecular Biology(all)
  • Agricultural and Biological Sciences(all)

Cite this

Cortes, C. P., Wehbe, F. H., McGowan, C. C., Shepherd, B. E., Duda, S. N., Jenkins, C. A., ... McGowan, C. C. (2013). Duration of Anti-Tuberculosis Therapy and Timing of Antiretroviral Therapy Initiation: Association with Mortality in HIV-Related Tuberculosis. PloS one, 8(9), [e74057]. https://doi.org/10.1371/journal.pone.0074057
Cortes, Claudia P. ; Wehbe, Firas H. ; McGowan, Catherine C. ; Shepherd, Bryan E. ; Duda, Stephany N. ; Jenkins, Cathy A. ; Gonzalez, Elsa ; Carriquiry, Gabriela ; Schechter, Mauro ; Padgett, Denis ; Cesar, Carina ; Madero, Juan Sierra ; Pape, Jean W. ; Masys, Daniel R. ; Sterling, Timothy R. ; Cortes, Claudia P. ; Wolff, Marcello ; Arancibia, José Miguel ; Saavedra, Felipe ; Salinas, Carolina ; Gonzalez, Elsa ; Carriquiry, Gabriela ; Mayer, Erick ; Condorhuaman, Patricia ; Gotuzzo, Eduardo ; Schechter, Mauro ; Tuboi, Suely H. ; Padgett, Denis ; Cesar, Carina ; Fink, Valeria ; Sued, Omar ; Cahn, Pedro ; Crabtree, Brenda ; Madero, Juan Sierra ; Bacon, Melanie ; Williams, Carolyn ; Wehbe, Firas H. ; Shepherd, Bryan E. ; Jenkins, Cathy A. ; Duda, Stephany N. ; Masys, Daniel R. ; McGowan, Catherine C. / Duration of Anti-Tuberculosis Therapy and Timing of Antiretroviral Therapy Initiation : Association with Mortality in HIV-Related Tuberculosis. In: PloS one. 2013 ; Vol. 8, No. 9.
@article{43b10afe99c245eeab059547f4065c8b,
title = "Duration of Anti-Tuberculosis Therapy and Timing of Antiretroviral Therapy Initiation: Association with Mortality in HIV-Related Tuberculosis",
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/mm 3 , 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.",
author = "Cortes, {Claudia P.} and Wehbe, {Firas H.} and McGowan, {Catherine C.} and Shepherd, {Bryan E.} and Duda, {Stephany N.} and Jenkins, {Cathy A.} and Elsa Gonzalez and Gabriela Carriquiry and Mauro Schechter and Denis Padgett and Carina Cesar and Madero, {Juan Sierra} and Pape, {Jean W.} and Masys, {Daniel R.} and Sterling, {Timothy R.} and Cortes, {Claudia P.} and Marcello Wolff and Arancibia, {Jos{\'e} Miguel} and Felipe Saavedra and Carolina Salinas and Elsa Gonzalez and Gabriela Carriquiry and Erick Mayer and Patricia Condorhuaman and Eduardo Gotuzzo and Mauro Schechter and Tuboi, {Suely H.} and Denis Padgett and Carina Cesar and Valeria Fink and Omar Sued and Pedro Cahn and Brenda Crabtree and Madero, {Juan Sierra} and Melanie Bacon and Carolyn Williams and Wehbe, {Firas H.} and Shepherd, {Bryan E.} and Jenkins, {Cathy A.} and Duda, {Stephany N.} and Masys, {Daniel R.} and McGowan, {Catherine C.}",
year = "2013",
month = "9",
day = "16",
doi = "10.1371/journal.pone.0074057",
language = "English (US)",
volume = "8",
journal = "PLoS One",
issn = "1932-6203",
publisher = "Public Library of Science",
number = "9",

}

Cortes, CP, Wehbe, FH, McGowan, CC, Shepherd, BE, Duda, SN, Jenkins, CA, Gonzalez, E, Carriquiry, G, Schechter, M, Padgett, D, Cesar, C, Madero, JS, Pape, JW, Masys, DR, Sterling, TR, Cortes, CP, Wolff, M, Arancibia, JM, Saavedra, F, Salinas, C, Gonzalez, E, Carriquiry, G, Mayer, E, Condorhuaman, P, Gotuzzo, E, Schechter, M, Tuboi, SH, Padgett, D, Cesar, C, Fink, V, Sued, O, Cahn, P, Crabtree, B, Madero, JS, Bacon, M, Williams, C, Wehbe, FH, Shepherd, BE, Jenkins, CA, Duda, SN, Masys, DR & McGowan, CC 2013, 'Duration of Anti-Tuberculosis Therapy and Timing of Antiretroviral Therapy Initiation: Association with Mortality in HIV-Related Tuberculosis', PloS one, vol. 8, no. 9, e74057. https://doi.org/10.1371/journal.pone.0074057

Duration of Anti-Tuberculosis Therapy and Timing of Antiretroviral Therapy Initiation : Association with Mortality in HIV-Related Tuberculosis. / Cortes, Claudia P.; Wehbe, Firas H.; McGowan, Catherine C.; Shepherd, Bryan E.; Duda, Stephany N.; Jenkins, Cathy A.; Gonzalez, Elsa; Carriquiry, Gabriela; Schechter, Mauro; Padgett, Denis; Cesar, Carina; Madero, Juan Sierra; Pape, Jean W.; Masys, Daniel R.; Sterling, Timothy R.; Cortes, Claudia P.; Wolff, Marcello; Arancibia, José Miguel; Saavedra, Felipe; Salinas, Carolina; Gonzalez, Elsa; Carriquiry, Gabriela; Mayer, Erick; Condorhuaman, Patricia; Gotuzzo, Eduardo; Schechter, Mauro; Tuboi, Suely H.; Padgett, Denis; Cesar, Carina; Fink, Valeria; Sued, Omar; Cahn, Pedro; Crabtree, Brenda; Madero, Juan Sierra; Bacon, Melanie; Williams, Carolyn; Wehbe, Firas H.; Shepherd, Bryan E.; Jenkins, Cathy A.; Duda, Stephany N.; Masys, Daniel R.; McGowan, Catherine C.

In: PloS one, Vol. 8, No. 9, e74057, 16.09.2013.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Duration of Anti-Tuberculosis Therapy and Timing of Antiretroviral Therapy Initiation

T2 - Association with Mortality in HIV-Related Tuberculosis

AU - Cortes, Claudia P.

AU - Wehbe, Firas H.

AU - McGowan, Catherine C.

AU - Shepherd, Bryan E.

AU - Duda, Stephany N.

AU - Jenkins, Cathy A.

AU - Gonzalez, Elsa

AU - Carriquiry, Gabriela

AU - Schechter, Mauro

AU - Padgett, Denis

AU - Cesar, Carina

AU - Madero, Juan Sierra

AU - Pape, Jean W.

AU - Masys, Daniel R.

AU - Sterling, Timothy R.

AU - Cortes, Claudia P.

AU - Wolff, Marcello

AU - Arancibia, José Miguel

AU - Saavedra, Felipe

AU - Salinas, Carolina

AU - Gonzalez, Elsa

AU - Carriquiry, Gabriela

AU - Mayer, Erick

AU - Condorhuaman, Patricia

AU - Gotuzzo, Eduardo

AU - Schechter, Mauro

AU - Tuboi, Suely H.

AU - Padgett, Denis

AU - Cesar, Carina

AU - Fink, Valeria

AU - Sued, Omar

AU - Cahn, Pedro

AU - Crabtree, Brenda

AU - Madero, Juan Sierra

AU - Bacon, Melanie

AU - Williams, Carolyn

AU - Wehbe, Firas H.

AU - Shepherd, Bryan E.

AU - Jenkins, Cathy A.

AU - Duda, Stephany N.

AU - Masys, Daniel R.

AU - McGowan, Catherine C.

PY - 2013/9/16

Y1 - 2013/9/16

N2 - 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/mm 3 , 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.

AB - 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/mm 3 , 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.

UR - http://www.scopus.com/inward/record.url?scp=84884200658&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84884200658&partnerID=8YFLogxK

U2 - 10.1371/journal.pone.0074057

DO - 10.1371/journal.pone.0074057

M3 - Article

VL - 8

JO - PLoS One

JF - PLoS One

SN - 1932-6203

IS - 9

M1 - e74057

ER -