HIV and TB co-infection in the ART era: CD4 count distributions and TB case fatality in Cape Town

dc.contributor.authorKaplan, Richard
dc.contributor.authorHermans, Sabine
dc.contributor.authorCaldwell, Judy
dc.contributor.authorJennings, Karen
dc.contributor.authorBekker, Linda-Gail
dc.contributor.authorWood, Robin
dc.date.accessioned2018-08-28T10:46:37Z
dc.date.available2018-08-28T10:46:37Z
dc.date.issued2018-07-31
dc.date.updated2018-08-05T03:50:08Z
dc.description.abstractBackground In Cape Town, the roll-out of antiretroviral therapy (ART) has increased over the last decade with an estimated coverage of 63% of HIV- positive patients in 2013. The influence of ART on the characteristics of the population of HIV-positive patients presenting to the primary care TB programme is unknown. In this study, we examined trends in CD4 count distribution, ART usage and treatment outcomes among HIV-positive TB patients in Cape Town from 2009 to 2013. Methods Data from the electronic TB register on all newly registered drug-sensitive TB patients ≥18 years were analyzed retrospectively. Descriptive statistics were used to compare baseline characteristics, the CD4 count distribution and TB treatment outcomes both by year of treatment and ART status at the start of TB treatment. Survival analyses were used to assess the change in mortality risk during TB treatment over time, stratified by ART status at start of TB treatment. Results 118,989 patients were treated over 5 years. HIV prevalence among TB patients decreased from 50.9% in 2009 to 49.0% in 2013. The absolute number of HIV-positive TB cases declined by 13.2% between 2010 and 2013. More patients entered the TB programme on ART in 2013 compared to 2009 (30.0% vs 9.9%). Among these, the CD4 count distribution showed a year by year shift to higher CD4 counts. In 2013, over 75% of ART-naïve TB patients still had a CD4 count < 350 cells/mm3. ART initiation among ART-naive patients increased from 37.0 to 77.7% and TB case fatality declined from 7.4 to 5.2% (p < 0.001). In multivariate analysis a decrease in TB mortality was most strongly associated with CD4 count (Adjusted HR 0.82 per increase of 50 cells/mm3, 95% CI: 0.81–0.83, p < 001) and the initiation of ART during TB treatment (Adjusted HR 0.39, 95% CI: 0.35–0.42, p < 0.001). Conclusion Comprehensive changes in the ART and TB treatment programmes resulted in incremental increases in ART coverage for HIV-positive TB patients and a subsequent decrease in TB case fatality due to increased ART uptake in HIV-positive ART-naïve patients. However TB still remained a major presenting opportunistic infection with the majority of cases occurring at low CD4 counts.
dc.identifier.apacitationKaplan, R., Hermans, S., Caldwell, J., Jennings, K., Bekker, L., & Wood, R. (2018). HIV and TB co-infection in the ART era: CD4 count distributions and TB case fatality in Cape Town. <i>BMC Infectious Diseases</i>, http://hdl.handle.net/11427/28340en_ZA
dc.identifier.chicagocitationKaplan, Richard, Sabine Hermans, Judy Caldwell, Karen Jennings, Linda-Gail Bekker, and Robin Wood "HIV and TB co-infection in the ART era: CD4 count distributions and TB case fatality in Cape Town." <i>BMC Infectious Diseases</i> (2018) http://hdl.handle.net/11427/28340en_ZA
dc.identifier.citationKaplan, R., Hermans, S., Caldwell, J., Jennings, K., Bekker, L. G., & Wood, R. (2018). HIV and TB co-infection in the ART era: CD4 count distributions and TB case fatality in Cape Town. BMC infectious diseases, 18(1), 356.
dc.identifier.ris TY - Journal Article AU - Kaplan, Richard AU - Hermans, Sabine AU - Caldwell, Judy AU - Jennings, Karen AU - Bekker, Linda-Gail AU - Wood, Robin AB - Background In Cape Town, the roll-out of antiretroviral therapy (ART) has increased over the last decade with an estimated coverage of 63% of HIV- positive patients in 2013. The influence of ART on the characteristics of the population of HIV-positive patients presenting to the primary care TB programme is unknown. In this study, we examined trends in CD4 count distribution, ART usage and treatment outcomes among HIV-positive TB patients in Cape Town from 2009 to 2013. Methods Data from the electronic TB register on all newly registered drug-sensitive TB patients ≥18 years were analyzed retrospectively. Descriptive statistics were used to compare baseline characteristics, the CD4 count distribution and TB treatment outcomes both by year of treatment and ART status at the start of TB treatment. Survival analyses were used to assess the change in mortality risk during TB treatment over time, stratified by ART status at start of TB treatment. Results 118,989 patients were treated over 5 years. HIV prevalence among TB patients decreased from 50.9% in 2009 to 49.0% in 2013. The absolute number of HIV-positive TB cases declined by 13.2% between 2010 and 2013. More patients entered the TB programme on ART in 2013 compared to 2009 (30.0% vs 9.9%). Among these, the CD4 count distribution showed a year by year shift to higher CD4 counts. In 2013, over 75% of ART-naïve TB patients still had a CD4 count < 350 cells/mm3. ART initiation among ART-naive patients increased from 37.0 to 77.7% and TB case fatality declined from 7.4 to 5.2% (p < 0.001). In multivariate analysis a decrease in TB mortality was most strongly associated with CD4 count (Adjusted HR 0.82 per increase of 50 cells/mm3, 95% CI: 0.81–0.83, p < 001) and the initiation of ART during TB treatment (Adjusted HR 0.39, 95% CI: 0.35–0.42, p < 0.001). Conclusion Comprehensive changes in the ART and TB treatment programmes resulted in incremental increases in ART coverage for HIV-positive TB patients and a subsequent decrease in TB case fatality due to increased ART uptake in HIV-positive ART-naïve patients. However TB still remained a major presenting opportunistic infection with the majority of cases occurring at low CD4 counts. DA - 2018-07-31 DB - OpenUCT DP - University of Cape Town J1 - BMC Infectious Diseases LK - https://open.uct.ac.za PB - University of Cape Town PY - 2018 T1 - HIV and TB co-infection in the ART era: CD4 count distributions and TB case fatality in Cape Town TI - HIV and TB co-infection in the ART era: CD4 count distributions and TB case fatality in Cape Town UR - http://hdl.handle.net/11427/28340 ER - en_ZA
dc.identifier.urihttps://doi.org/10.1186/s12879-018-3256-9
dc.identifier.urihttp://hdl.handle.net/11427/28340
dc.identifier.vancouvercitationKaplan R, Hermans S, Caldwell J, Jennings K, Bekker L, Wood R. HIV and TB co-infection in the ART era: CD4 count distributions and TB case fatality in Cape Town. BMC Infectious Diseases. 2018; http://hdl.handle.net/11427/28340.en_ZA
dc.language.isoen
dc.publisherBioMed Central
dc.publisher.departmentCentre for Infectious Disease Epidemiology and Research (CIDER)en_ZA
dc.publisher.facultyFaculty of Health Sciencesen_ZA
dc.publisher.institutionUniversity of Cape Town
dc.rights.holderThe Author(s).
dc.sourceBMC Infectious Diseases
dc.source.urihttps://bmcinfectdis.biomedcentral.com/
dc.subject.otherTuberculosis
dc.subject.otherHIV
dc.subject.otherAntiretroviral therapy
dc.subject.otherMortality
dc.subject.otherTB case fatality
dc.subject.otherCD4 count
dc.titleHIV and TB co-infection in the ART era: CD4 count distributions and TB case fatality in Cape Town
dc.typeJournal Article
uct.type.filetypeText
uct.type.filetypeImage
Files
Original bundle
Now showing 1 - 1 of 1
Loading...
Thumbnail Image
Name:
Kaplan_2018_Article.pdf
Size:
1.11 MB
Format:
Adobe Portable Document Format
Description:
License bundle
Now showing 1 - 1 of 1
Loading...
Thumbnail Image
Name:
license.txt
Size:
1.72 KB
Format:
Item-specific license agreed upon to submission
Description:
Collections