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 SalinasElsa 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/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.

    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)
    • General

    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/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.",
    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",
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    number = "9",

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    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/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.

    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/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.

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    DO - 10.1371/journal.pone.0074057

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