Factors associated with and characteristic of hiv/tuberculosis co-infection: a retrospective analysis of second-line clinical trial participants

Henry, Rebecca T. and Jiamsakul, Awachana and Law, Matthew and Losso, Marcelo and Kamarulzaman, Adeeba and Phanuphak, Praphan and Kumarasamy, Nagalingeswaran and Foulkes, Sharne and Mohapi, Lerato and Nwizu, Chidi and Wood, Robin and Kelleher, Anthony and Polizzotto, Mark and Grp, SECOND-LINE Study (2021) Factors associated with and characteristic of hiv/tuberculosis co-infection: a retrospective analysis of second-line clinical trial participants. Journal of Acquired Immune Deficiency Syndromes, 87 (1). pp. 720-729. ISSN 1525-4135, DOI https://doi.org/10.1097/QAI.0000000000002619.

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Background: Tuberculosis (TB) is a common infection in people living with HIV. However, the risk factors for HIV/TB co-infection in second-line HIV therapy are poorly understood. We aimed to determine the incidence and risk factors for TB co-infection in SECOND-LINE, an international randomized clinical trial of second-line HIV therapy. Methods: We did a cohort analysis of TB cases in SECOND-LINE. TB cases included any clinical or laboratory-confirmed diagnoses and/or commencement of treatment for TB after randomization. Baseline factors associated with TB were analyzed using Cox regression stratified by site. Results: TB cases occurred at sites in Argentina, India, Malaysia, Nigeria, South Africa, and Thailand, in a cohort of 355 of the 541 SECOND-LINE participants. Overall, 20 cases of TB occurred, an incidence rate of 3.4 per 100 person-years (95% CI: 2.1 to 5.1). Increased TB risk was associated with a low CD4(+)-cell count (<= 200 cells/mu L), high viral load (>200 copies/mL), low platelet count (<150 x10(9)/L), and low total serum cholesterol (<= 4.5 mmol/L) at baseline. An increased risk of death was associated with TB, adjusted for CD4, platelets, and cholesterol. A low CD4(+)-cell count was significantly associated with incident TB, mortality, other AIDS diagnoses, and virologic failure. Discussion: The risk of TB remains elevated in PLHIV in the setting of second-line HIV therapy in TB endemic regions. TB was associated with a greater risk of death. Finding that low CD4(+) T-cell count was significantly associated with poor outcomes in this population supports the value of CD4(+) monitoring in HIV clinical management.

Item Type: Article
Funders: Australian Government Department of Industry, Innovation and Science
Uncontrolled Keywords: HIV; tuberculosis; second-line antiretroviral therapy; risk factors; incidence; Cox regression
Subjects: R Medicine > R Medicine (General)
Divisions: Faculty of Medicine > Medicine Department
Depositing User: Ms Zaharah Ramly
Date Deposited: 31 May 2022 08:07
Last Modified: 31 May 2022 08:07
URI: http://eprints.um.edu.my/id/eprint/34514

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