Prevalent and incident tuberculosis are independent risk factors for mortality among patients accessing antiretroviral therapy in South Africa

dc.contributor.authorGupta, Ankuren_ZA
dc.contributor.authorWood, Robinen_ZA
dc.contributor.authorKaplan, Richarden_ZA
dc.contributor.authorBekker, Linda-Gailen_ZA
dc.contributor.authorLawn, Stephen Den_ZA
dc.date.accessioned2016-01-11T06:50:18Z
dc.date.available2016-01-11T06:50:18Z
dc.date.issued2013en_ZA
dc.description.abstractBACKGROUND: Patients with prevalent or incident tuberculosis (TB) in antiretroviral treatment (ART) programmes in sub-Saharan Africa have high mortality risk. However, published data are contradictory as to whether TB is a risk factor for mortality that is independent of CD4 cell counts and other patient characteristics. Methods/FINDINGS: This observational ART cohort study was based in Cape Town, South Africa. Deaths from all causes were ascertained among patients receiving ART for up to 8 years. TB diagnoses and 4-monthly CD4 cell counts were recorded. Mortality rates were calculated and Poisson regression models were used to calculate incidence rate ratios (IRR) and identify risk factors for mortality. Of 1544 patients starting ART, 464 patients had prevalent TB at baseline and 424 developed incident TB during a median of 5.0 years follow-up. Most TB diagnoses (73.6%) were culture-confirmed. A total of 208 (13.5%) patients died during ART and mortality rates were 8.84 deaths/100 person-years during the first year of ART and decreased to 1.14 deaths/100 person-years after 5 years. In multivariate analyses adjusted for baseline and time-updated risk factors, both prevalent and incident TB were independent risk factors for mortality (IRR 1.7 [95% CI, 1.2-2.3] and 2.7 [95% CI, 1.9-3.8], respectively). Adjusted mortality risks were higher in the first 6 months of ART for those with prevalent TB at baseline (IRR 2.33; 95% CI, 1.5-3.5) and within the 6 months following diagnoses of incident TB (IRR 3.8; 95% CI, 2.6-5.7). CONCLUSIONS: Prevalent TB at baseline and incident TB during ART were strongly associated with increased mortality risk. This effect was time-dependent, suggesting that TB and mortality are likely to be causally related and that TB is not simply an epiphenomenon among highly immunocompromised patients. Strategies to rapidly diagnose, treat and prevent TB prior to and during ART urgently need to be implemented.en_ZA
dc.identifier.apacitationGupta, A., Wood, R., Kaplan, R., Bekker, L., & Lawn, S. D. (2013). Prevalent and incident tuberculosis are independent risk factors for mortality among patients accessing antiretroviral therapy in South Africa. <i>PLoS One</i>, http://hdl.handle.net/11427/16234en_ZA
dc.identifier.chicagocitationGupta, Ankur, Robin Wood, Richard Kaplan, Linda-Gail Bekker, and Stephen D Lawn "Prevalent and incident tuberculosis are independent risk factors for mortality among patients accessing antiretroviral therapy in South Africa." <i>PLoS One</i> (2013) http://hdl.handle.net/11427/16234en_ZA
dc.identifier.citationGupta, A., Wood, R., Kaplan, R., Bekker, L. G., & Lawn, S. D. (2013). Prevalent and incident tuberculosis are independent risk factors for mortality among patients accessing antiretroviral therapy in South Africa. PloS one, 8(2), e55824. doi:10.1371/journal.pone.0055824en_ZA
dc.identifier.ris TY - Journal Article AU - Gupta, Ankur AU - Wood, Robin AU - Kaplan, Richard AU - Bekker, Linda-Gail AU - Lawn, Stephen D AB - BACKGROUND: Patients with prevalent or incident tuberculosis (TB) in antiretroviral treatment (ART) programmes in sub-Saharan Africa have high mortality risk. However, published data are contradictory as to whether TB is a risk factor for mortality that is independent of CD4 cell counts and other patient characteristics. Methods/FINDINGS: This observational ART cohort study was based in Cape Town, South Africa. Deaths from all causes were ascertained among patients receiving ART for up to 8 years. TB diagnoses and 4-monthly CD4 cell counts were recorded. Mortality rates were calculated and Poisson regression models were used to calculate incidence rate ratios (IRR) and identify risk factors for mortality. Of 1544 patients starting ART, 464 patients had prevalent TB at baseline and 424 developed incident TB during a median of 5.0 years follow-up. Most TB diagnoses (73.6%) were culture-confirmed. A total of 208 (13.5%) patients died during ART and mortality rates were 8.84 deaths/100 person-years during the first year of ART and decreased to 1.14 deaths/100 person-years after 5 years. In multivariate analyses adjusted for baseline and time-updated risk factors, both prevalent and incident TB were independent risk factors for mortality (IRR 1.7 [95% CI, 1.2-2.3] and 2.7 [95% CI, 1.9-3.8], respectively). Adjusted mortality risks were higher in the first 6 months of ART for those with prevalent TB at baseline (IRR 2.33; 95% CI, 1.5-3.5) and within the 6 months following diagnoses of incident TB (IRR 3.8; 95% CI, 2.6-5.7). CONCLUSIONS: Prevalent TB at baseline and incident TB during ART were strongly associated with increased mortality risk. This effect was time-dependent, suggesting that TB and mortality are likely to be causally related and that TB is not simply an epiphenomenon among highly immunocompromised patients. Strategies to rapidly diagnose, treat and prevent TB prior to and during ART urgently need to be implemented. DA - 2013 DB - OpenUCT DO - 10.1371/journal.pone.0055824 DP - University of Cape Town J1 - PLoS One LK - https://open.uct.ac.za PB - University of Cape Town PY - 2013 T1 - Prevalent and incident tuberculosis are independent risk factors for mortality among patients accessing antiretroviral therapy in South Africa TI - Prevalent and incident tuberculosis are independent risk factors for mortality among patients accessing antiretroviral therapy in South Africa UR - http://hdl.handle.net/11427/16234 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/16234
dc.identifier.urihttp://dx.doi.org/10.1371/journal.pone.0055824
dc.identifier.vancouvercitationGupta A, Wood R, Kaplan R, Bekker L, Lawn SD. Prevalent and incident tuberculosis are independent risk factors for mortality among patients accessing antiretroviral therapy in South Africa. PLoS One. 2013; http://hdl.handle.net/11427/16234.en_ZA
dc.language.isoengen_ZA
dc.publisherPublic Library of Scienceen_ZA
dc.publisher.departmentDesmond Tutu HIV Centreen_ZA
dc.publisher.facultyFaculty of Health Sciencesen_ZA
dc.publisher.institutionUniversity of Cape Town
dc.rightsThis 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.holder© 2013 Gupta et alen_ZA
dc.rights.urihttp://creativecommons.org/licenses/by/4.0en_ZA
dc.sourcePLoS Oneen_ZA
dc.source.urihttp://journals.plos.org/plosoneen_ZA
dc.subject.otherTuberculosisen_ZA
dc.subject.otherAntiretroviral therapyen_ZA
dc.subject.otherTuberculosis diagnosis and managementen_ZA
dc.subject.otherDeath ratesen_ZA
dc.subject.otherHistory of tuberculosisen_ZA
dc.subject.otherViral loaden_ZA
dc.subject.otherMycobacterium tuberculosisen_ZA
dc.subject.otherDiagnostic medicineen_ZA
dc.titlePrevalent and incident tuberculosis are independent risk factors for mortality among patients accessing antiretroviral therapy in South Africaen_ZA
dc.typeJournal Articleen_ZA
uct.type.filetypeText
uct.type.filetypeImage
uct.type.publicationResearchen_ZA
uct.type.resourceArticleen_ZA
Files
Original bundle
Now showing 1 - 1 of 1
Loading...
Thumbnail Image
Name:
Gupta_Prevalent_and_Incident_Tuberculosis_2013.pdf
Size:
270.04 KB
Format:
Adobe Portable Document Format
Description:
Collections