Clinical deterioration during antituberculosis treatment in Africa: Incidence, causes and risk factors

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dc.contributor.authorPepper, Dominiqueen_ZA
dc.contributor.authorMarais, Suzaanen_ZA
dc.contributor.authorWilkinson, Roberten_ZA
dc.contributor.authorBhaijee, Feriylen_ZA
dc.contributor.authorMaartens, Garyen_ZA
dc.contributor.authorMcIlleron, Helenen_ZA
dc.contributor.authorDe Azevedo, Virginiaen_ZA
dc.contributor.authorCox, Helenen_ZA
dc.contributor.authorMcDermid, Cherylen_ZA
dc.contributor.authorSokhela, Simisoen_ZA
dc.contributor.authorPatel, Janishaen_ZA
dc.contributor.authorMeintjes, Graemeen_ZA
dc.date.accessioned2015-10-30T09:30:43Z
dc.date.available2015-10-30T09:30:43Z
dc.date.issued2010en_ZA
dc.description.abstractBACKGROUND:HIV-1 and Mycobacterium tuberculosis cause substantial morbidity and mortality. Despite the availability of antiretroviral and antituberculosis treatment in Africa, clinical deterioration during antituberculosis treatment remains a frequent reason for hospital admission. We therefore determined the incidence, causes and risk factors for clinical deterioration. METHODS: Prospective cohort study of 292 adults who initiated antituberculosis treatment during a 3-month period. We evaluated those with clinical deterioration over the following 24 weeks of treatment. RESULTS: Seventy-one percent (209/292) of patients were HIV-1 infected (median CD4+: 129 cells/muL [IQR:62-277]). At tuberculosis diagnosis, 23% (34/145) of HIV-1 infected patients qualifying for antiretroviral treatment (ART) were receiving ART; 6 months later, 75% (109/145) had received ART. Within 24 weeks of initiating antituberculosis treatment, 40% (117/292) of patients experienced clinical deterioration due to co-morbid illness (n = 70), tuberculosis related illness (n = 47), non AIDS-defining HIV-1 related infection (n = 25) and AIDS-defining illness (n = 21). Using HIV-1 uninfected patients as the referent group, HIV-1 infected patients had an increasing risk of clinical deterioration as CD4+ counts decreased [CD4+>350 cells/muL: RR = 1.4, 95% CI = 0.7-2.9; CD4+:200-350 cells/muL: RR = 2.0, 95% CI = 1.1-3.6; CD4+<200 cells/muL: RR = 3.0, 95% CI = 1.9-4.7]. During follow-up, 26% (30/117) of patients with clinical deterioration required hospital admission and 15% (17/117) died. Fifteen deaths were in HIV-1 infected patients with a CD4+<200 cells/muL. CONCLUSIONS: In multivariate analysis, HIV-1 infection and a low CD4+ count at tuberculosis diagnosis were significant risk factors for clinical deterioration and death. The initiation of ART at a CD4+ count of <350 cells/muL will likely reduce the high burden of clinical deterioration.en_ZA
dc.identifier.apacitationPepper, D., Marais, S., Wilkinson, R., Bhaijee, F., Maartens, G., McIlleron, H., ... Meintjes, G. (2010). Clinical deterioration during antituberculosis treatment in Africa: Incidence, causes and risk factors. <i>BMC Infectious Diseases</i>, http://hdl.handle.net/11427/14508en_ZA
dc.identifier.chicagocitationPepper, Dominique, Suzaan Marais, Robert Wilkinson, Feriyl Bhaijee, Gary Maartens, Helen McIlleron, Virginia De Azevedo, et al "Clinical deterioration during antituberculosis treatment in Africa: Incidence, causes and risk factors." <i>BMC Infectious Diseases</i> (2010) http://hdl.handle.net/11427/14508en_ZA
dc.identifier.citationPepper, D. J., Marais, S., Wilkinson, R. J., Bhaijee, F., Maartens, G., McIlleron, H., ... & Meintjes, G. (2010). Clinical deterioration during antituberculosis treatment in Africa: Incidence, causes and risk factors. BMC infectious diseases, 10(1), 83.en_ZA
dc.identifier.ris TY - Journal Article AU - Pepper, Dominique AU - Marais, Suzaan AU - Wilkinson, Robert AU - Bhaijee, Feriyl AU - Maartens, Gary AU - McIlleron, Helen AU - De Azevedo, Virginia AU - Cox, Helen AU - McDermid, Cheryl AU - Sokhela, Simiso AU - Patel, Janisha AU - Meintjes, Graeme AB - BACKGROUND:HIV-1 and Mycobacterium tuberculosis cause substantial morbidity and mortality. Despite the availability of antiretroviral and antituberculosis treatment in Africa, clinical deterioration during antituberculosis treatment remains a frequent reason for hospital admission. We therefore determined the incidence, causes and risk factors for clinical deterioration. METHODS: Prospective cohort study of 292 adults who initiated antituberculosis treatment during a 3-month period. We evaluated those with clinical deterioration over the following 24 weeks of treatment. RESULTS: Seventy-one percent (209/292) of patients were HIV-1 infected (median CD4+: 129 cells/muL [IQR:62-277]). At tuberculosis diagnosis, 23% (34/145) of HIV-1 infected patients qualifying for antiretroviral treatment (ART) were receiving ART; 6 months later, 75% (109/145) had received ART. Within 24 weeks of initiating antituberculosis treatment, 40% (117/292) of patients experienced clinical deterioration due to co-morbid illness (n = 70), tuberculosis related illness (n = 47), non AIDS-defining HIV-1 related infection (n = 25) and AIDS-defining illness (n = 21). Using HIV-1 uninfected patients as the referent group, HIV-1 infected patients had an increasing risk of clinical deterioration as CD4+ counts decreased [CD4+>350 cells/muL: RR = 1.4, 95% CI = 0.7-2.9; CD4+:200-350 cells/muL: RR = 2.0, 95% CI = 1.1-3.6; CD4+<200 cells/muL: RR = 3.0, 95% CI = 1.9-4.7]. During follow-up, 26% (30/117) of patients with clinical deterioration required hospital admission and 15% (17/117) died. Fifteen deaths were in HIV-1 infected patients with a CD4+<200 cells/muL. CONCLUSIONS: In multivariate analysis, HIV-1 infection and a low CD4+ count at tuberculosis diagnosis were significant risk factors for clinical deterioration and death. The initiation of ART at a CD4+ count of <350 cells/muL will likely reduce the high burden of clinical deterioration. DA - 2010 DB - OpenUCT DO - 10.1186/1471-2334-10-83 DP - University of Cape Town J1 - BMC Infectious Diseases LK - https://open.uct.ac.za PB - University of Cape Town PY - 2010 T1 - Clinical deterioration during antituberculosis treatment in Africa: Incidence, causes and risk factors TI - Clinical deterioration during antituberculosis treatment in Africa: Incidence, causes and risk factors UR - http://hdl.handle.net/11427/14508 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/14508
dc.identifier.urihttp://dx.doi.org/10.1186/1471-2334-10-83
dc.identifier.vancouvercitationPepper D, Marais S, Wilkinson R, Bhaijee F, Maartens G, McIlleron H, et al. Clinical deterioration during antituberculosis treatment in Africa: Incidence, causes and risk factors. BMC Infectious Diseases. 2010; http://hdl.handle.net/11427/14508.en_ZA
dc.language.isoengen_ZA
dc.publisherBioMed Central Ltden_ZA
dc.publisher.departmentInstitute of Infectious Disease and Molecular Medicineen_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 Licenseen_ZA
dc.rights.holder2010 Pepper et al; licensee BioMed Central Ltd.en_ZA
dc.rights.urihttp://creativecommons.org/licenses/by/2.0en_ZA
dc.sourceBMC Infectious Diseasesen_ZA
dc.source.urihttp://www.biomedcentral.com/bmcinfectdis/en_ZA
dc.subject.otherAntiretroviral Therapyen_ZA
dc.subject.otherAnti-HIV Agentsen_ZA
dc.subject.otherAntitubercular Agentsen_ZA
dc.subject.otherHIV Infectionsen_ZA
dc.titleClinical deterioration during antituberculosis treatment in Africa: Incidence, causes and risk factorsen_ZA
dc.typeJournal Articleen_ZA
uct.type.filetypeText
uct.type.filetypeImage
uct.type.publicationResearchen_ZA
uct.type.resourceArticleen_ZA
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