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

    4 Scopus citations

    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

    ASJC Scopus subject areas

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

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    Cortes, C. P., Wehbe, F. H., McGowan, C. C., Shepherd, B. E., Duda, S. N., Jenkins, C. A., Gonzalez, E., Carriquiry, G., Schechter, M., Padgett, D., Cesar, C., Madero, J. S., Pape, J. W., Masys, D. R., Sterling, T. R., Cortes, C. P., Wolff, M., Arancibia, J. M., Saavedra, F., ... 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