Complications of antiretroviral therapy initiation in hospitalised patients with HIV-associated tuberculosis

 

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dc.contributor.author van der Plas, Helen en_ZA
dc.contributor.author Meintjes, Graeme en_ZA
dc.contributor.author Schutz, Charlotte en_ZA
dc.contributor.author Goliath, Rene en_ZA
dc.contributor.author Myer, Landon en_ZA
dc.contributor.author Baatjie, Dorothea en_ZA
dc.contributor.author Wilkinson, Robert J en_ZA
dc.contributor.author Maartens, Gary en_ZA
dc.contributor.author Mendelson, Marc en_ZA
dc.date.accessioned 2015-12-20T16:05:16Z
dc.date.available 2015-12-20T16:05:16Z
dc.date.issued 2013 en_ZA
dc.identifier.citation van der Plas, H., Meintjes, G., Schutz, C., Goliath, R., Myer, L., Baatjie, D., ... & Mendelson, M. (2013). Complications of antiretroviral therapy initiation in hospitalised patients with HIV-associated tuberculosis. PloS one, 8(2), e54145. doi:10.1371/journal.pone.0054145 en_ZA
dc.identifier.uri http://hdl.handle.net/11427/15917
dc.identifier.uri http://dx.doi.org/10.1371/journal.pone.0054145
dc.description.abstract BACKGROUND: HIV-associated tuberculosis is a common coinfection in Sub-Saharan Africa, which causes high morbidity and mortality. A sub-set of HIV-associated tuberculosis patients require prolonged hospital admission, during which antiretroviral therapy initiation may be required. The aim of this study was to document the causes of clinical deterioration of hospitalised patients with HIV-associated tuberculosis starting antiretroviral therapy in order to inform healthcare practice in low- to middle-income countries. METHODS: Prospective, observational cohort study of adult inpatients with HIV-associated tuberculosis starting antiretroviral therapy in a dedicated tuberculosis hospital in Cape Town, South Africa. Causes of clinical deterioration and outcome were recorded in the first 12 weeks of antiretroviral therapy. Patients with rifampicin-resistant tuberculosis were excluded. RESULTS: Between May 2009 and November 2010, 112 patients (60% female), with a median age of 32 years were enrolled. At baseline the median CD4 count was 55 cells/mm 3 (IQR 31-106) and HIV viral load 5.6 log copies/mL. All patients had significant comorbidity: 82% were bed-bound, 65% had disseminated tuberculosis and 27% had central nervous system tuberculosis. Seventy six patients (68%) developed 144 clinical events after starting antiretroviral therapy. TB-IRIS, hospital-acquired infections and significant drug toxicities occurred in 42%, 20.5% and 15% of patients respectively. A new opportunistic disease occurred in 15% of patients and a thromboembolic event in 8%. Mortality during the 12 week period was 10.6%. CONCLUSIONS: High rates of TB-IRIS, hospital-acquired infections and drug toxicities complicate the course of patients with HIV-associated tuberculosis starting antiretroviral therapy in hospital. Despite the high morbidity, mortality was relatively low. Careful clinical management and adequate resources are needed in hospitalised HIV-TB patients in the 1 st three months following ART initiation. en_ZA
dc.language.iso eng en_ZA
dc.publisher Public Library of Science en_ZA
dc.rights This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. en_ZA
dc.rights.uri http://creativecommons.org/licenses/by/4.0 en_ZA
dc.source PLoS One en_ZA
dc.source.uri http://journals.plos.org/plosone en_ZA
dc.subject.other Tuberculosis en_ZA
dc.subject.other Antiretroviral therapy en_ZA
dc.subject.other Tuberculosis diagnosis and management en_ZA
dc.subject.other Nosocomial infections en_ZA
dc.subject.other Hospitals en_ZA
dc.subject.other Inpatients en_ZA
dc.subject.other Extensively drug-resistant tuberculosis en_ZA
dc.subject.other Toxicity en_ZA
dc.title Complications of antiretroviral therapy initiation in hospitalised patients with HIV-associated tuberculosis en_ZA
dc.type Journal Article en_ZA
dc.rights.holder © 2013 van der Plas et al en_ZA
uct.type.publication Research en_ZA
uct.type.resource Article en_ZA
dc.publisher.institution University of Cape Town
dc.publisher.faculty Faculty of Health Sciences en_ZA
dc.publisher.department Institute of Infectious Disease and Molecular Medicine en_ZA
uct.type.filetype Text
uct.type.filetype Image


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This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Except where otherwise noted, this item's license is described as This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.