Tuberculosis After HAART Initiation in HIV-Positive Patients from Five Countries with a High Tuberculosis Burden.

Hdl Handle:
http://hdl.handle.net/10144/18313
Title:
Tuberculosis After HAART Initiation in HIV-Positive Patients from Five Countries with a High Tuberculosis Burden.
Authors:
Bonnet, M; Pinoges, L; Varaine, F; Oberhauser, B O; O'Brien, D P; Kebede, Y; Hewison, C; Zachariah, R; Ferradini, L
Journal:
AIDS (London, England)
Abstract:
BACKGROUND: HAART reduces tuberculosis (TB) incidence in people living with HIV/AIDS but those starting HAART may develop active TB or subclinical TB may become apparent in the immune reconstitution inflammatory syndrome. OBJECTIVE: To measure the incidence rate of notified TB in people receiving HAART in five HIV programmes occurring in low-resource countries with a high TB/HIV burden. METHODS: A retrospective review in five Médecins Sans Frontières programmes (Cambodia, Thailand, Kenya, Malawi and Cameroon) allowed incidence rates of notified TB to be calculated based on follow-up time after HAART initiation. RESULT: Among 3151 patients analysed, 90% had a CD4 cell count of < 200 cells/mul. Median follow-up time ranged from 3.7 months in Thailand or Kenya to 11.1 months in Cambodia. Incidence rates were 7.6, 10.4, 17.6, 14.3 and 4.8/100 person-years for pulmonary TB and 12.7, 4.3, 6.9, 2.1 and 0/100 person-years for extra-pulmonary TB in the programmes in Cambodia, Thailand, Kenya, Malawi and Cameroon, respectively. Overall, 62.3% of pulmonary TB and 54.9% of extra-pulmonary TB were diagnosed within 3 months after HAART initiation. CONCLUSION: High incidence rates of notified TB under HAART in programmes held in poor-resource countries were observed; these were likely to include both undiagnosed prevalent TB at HAART initiation and subclinical TB developing during the immune reconstitution inflammatory syndrome. This raises operational issues concerning TB diagnosis and treatment of TB/HIV-coinfected patients and prompts for urgent TB and HIV care integration.
Affiliation:
MSF Epicentre, Médecins Sans Frontieres, Paris, France. maryline.bonnet@geneva.msf.org
Issue Date:
12-Jun-2006
URI:
http://hdl.handle.net/10144/18313
DOI:
10.1097/01.aids.0000232235.26630.ee
PubMed ID:
16816556
Language:
en
ISSN:
0269-9370
Appears in Collections:
TB

Full metadata record

DC FieldValue Language
dc.contributor.authorBonnet, M-
dc.contributor.authorPinoges, L-
dc.contributor.authorVaraine, F-
dc.contributor.authorOberhauser, B O-
dc.contributor.authorO'Brien, D P-
dc.contributor.authorKebede, Y-
dc.contributor.authorHewison, C-
dc.contributor.authorZachariah, R-
dc.contributor.authorFerradini, L-
dc.date.accessioned2008-02-14T14:32:50Z-
dc.date.available2008-02-14T14:32:50Z-
dc.date.issued2006-06-12-
dc.identifier.citationTuberculosis After HAART Initiation in HIV-Positive Patients from Five Countries with a High Tuberculosis Burden. 2006, 20 (9):1275-9 AIDSen
dc.identifier.issn0269-9370-
dc.identifier.pmid16816556-
dc.identifier.doi10.1097/01.aids.0000232235.26630.ee-
dc.identifier.urihttp://hdl.handle.net/10144/18313-
dc.description.abstractBACKGROUND: HAART reduces tuberculosis (TB) incidence in people living with HIV/AIDS but those starting HAART may develop active TB or subclinical TB may become apparent in the immune reconstitution inflammatory syndrome. OBJECTIVE: To measure the incidence rate of notified TB in people receiving HAART in five HIV programmes occurring in low-resource countries with a high TB/HIV burden. METHODS: A retrospective review in five Médecins Sans Frontières programmes (Cambodia, Thailand, Kenya, Malawi and Cameroon) allowed incidence rates of notified TB to be calculated based on follow-up time after HAART initiation. RESULT: Among 3151 patients analysed, 90% had a CD4 cell count of < 200 cells/mul. Median follow-up time ranged from 3.7 months in Thailand or Kenya to 11.1 months in Cambodia. Incidence rates were 7.6, 10.4, 17.6, 14.3 and 4.8/100 person-years for pulmonary TB and 12.7, 4.3, 6.9, 2.1 and 0/100 person-years for extra-pulmonary TB in the programmes in Cambodia, Thailand, Kenya, Malawi and Cameroon, respectively. Overall, 62.3% of pulmonary TB and 54.9% of extra-pulmonary TB were diagnosed within 3 months after HAART initiation. CONCLUSION: High incidence rates of notified TB under HAART in programmes held in poor-resource countries were observed; these were likely to include both undiagnosed prevalent TB at HAART initiation and subclinical TB developing during the immune reconstitution inflammatory syndrome. This raises operational issues concerning TB diagnosis and treatment of TB/HIV-coinfected patients and prompts for urgent TB and HIV care integration.en
dc.language.isoenen
dc.rightsPublished by Wolters Kluwer Lippincott Williams & Wilkins - Archived on this site by kind permission Wolters Kluweren
dc.subject.meshAdulten
dc.subject.meshAntiretroviral Therapy, Highly Activeen
dc.subject.meshAntiviral Agentsen
dc.subject.meshCambodiaen
dc.subject.meshCameroonen
dc.subject.meshConfidence Intervalsen
dc.subject.meshDeveloping Countriesen
dc.subject.meshEndemic Diseasesen
dc.subject.meshFemaleen
dc.subject.meshFollow-Up Studiesen
dc.subject.meshHIV Infectionsen
dc.subject.meshHIV-1en
dc.subject.meshHumansen
dc.subject.meshIncidenceen
dc.subject.meshKenyaen
dc.subject.meshMalawien
dc.subject.meshMaleen
dc.subject.meshThailanden
dc.subject.meshTime Factorsen
dc.subject.meshTuberculosisen
dc.titleTuberculosis After HAART Initiation in HIV-Positive Patients from Five Countries with a High Tuberculosis Burden.en
dc.contributor.departmentMSF Epicentre, Médecins Sans Frontieres, Paris, France. maryline.bonnet@geneva.msf.orgen
dc.identifier.journalAIDS (London, England)en

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