Long-term HIV and tuberculosis outcomes in co-infected patients with treatment limiting severe cutaneous adverse reactions
| dc.contributor.advisor | Peter, Jonathan | |
| dc.contributor.author | Veenstra, Simon | |
| dc.date.accessioned | 2024-07-02T10:12:17Z | |
| dc.date.available | 2024-07-02T10:12:17Z | |
| dc.date.issued | 2023 | |
| dc.date.updated | 2024-06-06T13:53:08Z | |
| dc.description.abstract | Background Treatment-limiting severe cutaneous adverse reactions (SCAR) occur more commonly amongst persons co-infected with tuberculosis (TB) and advanced HIV. The impact of SCAR on long-term HIV and TB outcomes is unknown. Methods Patients with active TB and/or HIV admitted to Groote Schuur Hospital, Cape Town, South Africa with SCAR between 1/10/2018 and 30/09/2021 were eligible. Clinical and laboratory follow-up data was collected for 6 and 12-month outcomes: mortality, TB and antiretroviral therapy (ART) regimen changes, TB treatment completion, and CD4 count recovery. Results Forty-eight SCAR admissions included: 34, 11, and 3 HIV-associated TB, HIV-only and TB-only patients with 32, 13 and 3 cases of drug reaction with eosinophilia and systemic symptoms, StevensJohnson syndrome/toxic epidermal necrolysis and generalised bullous fixed drug eruption respectively. Nine (19%), all HIV-positive, were deceased at 12-months, and 12 (25%) were lost to all care levels. Amongst TB-SCAR patients, seven (21%) were discharged on all four first-line anti-TB drugs (FLTD), while 12 (33%) had discharge regimens with no FLTDs; 24/37 (65%) completed TB treatment. Amongst HIV-SCAR patients, 10/31 (32%) changed ART regimen. If retained in care (24/36), median (IQR) CD4 counts increased by 12-months post-SCAR (115 (62-175) vs. 319 (134-439) cells/uL). Conclusion SCAR admission amongst patients with HIV-associated TB results in substantial mortality, and considerable treatment complexity. However, if retained in care, TB regimens are successfully completed, and immune recovery is good despite SCAR. | |
| dc.identifier.apacitation | Veenstra, S. (2023). <i>Long-term HIV and tuberculosis outcomes in co-infected patients with treatment limiting severe cutaneous adverse reactions</i>. (). ,Faculty of Health Sciences ,Department of Medicine. Retrieved from http://hdl.handle.net/11427/40194 | en_ZA |
| dc.identifier.chicagocitation | Veenstra, Simon. <i>"Long-term HIV and tuberculosis outcomes in co-infected patients with treatment limiting severe cutaneous adverse reactions."</i> ., ,Faculty of Health Sciences ,Department of Medicine, 2023. http://hdl.handle.net/11427/40194 | en_ZA |
| dc.identifier.citation | Veenstra, S. 2023. Long-term HIV and tuberculosis outcomes in co-infected patients with treatment limiting severe cutaneous adverse reactions. . ,Faculty of Health Sciences ,Department of Medicine. http://hdl.handle.net/11427/40194 | en_ZA |
| dc.identifier.ris | TY - Thesis / Dissertation AU - Veenstra, Simon AB - Background Treatment-limiting severe cutaneous adverse reactions (SCAR) occur more commonly amongst persons co-infected with tuberculosis (TB) and advanced HIV. The impact of SCAR on long-term HIV and TB outcomes is unknown. Methods Patients with active TB and/or HIV admitted to Groote Schuur Hospital, Cape Town, South Africa with SCAR between 1/10/2018 and 30/09/2021 were eligible. Clinical and laboratory follow-up data was collected for 6 and 12-month outcomes: mortality, TB and antiretroviral therapy (ART) regimen changes, TB treatment completion, and CD4 count recovery. Results Forty-eight SCAR admissions included: 34, 11, and 3 HIV-associated TB, HIV-only and TB-only patients with 32, 13 and 3 cases of drug reaction with eosinophilia and systemic symptoms, StevensJohnson syndrome/toxic epidermal necrolysis and generalised bullous fixed drug eruption respectively. Nine (19%), all HIV-positive, were deceased at 12-months, and 12 (25%) were lost to all care levels. Amongst TB-SCAR patients, seven (21%) were discharged on all four first-line anti-TB drugs (FLTD), while 12 (33%) had discharge regimens with no FLTDs; 24/37 (65%) completed TB treatment. Amongst HIV-SCAR patients, 10/31 (32%) changed ART regimen. If retained in care (24/36), median (IQR) CD4 counts increased by 12-months post-SCAR (115 (62-175) vs. 319 (134-439) cells/uL). Conclusion SCAR admission amongst patients with HIV-associated TB results in substantial mortality, and considerable treatment complexity. However, if retained in care, TB regimens are successfully completed, and immune recovery is good despite SCAR. DA - 2023 DB - OpenUCT DP - University of Cape Town KW - Internal Medicine LK - https://open.uct.ac.za PY - 2023 T1 - Long-term HIV and tuberculosis outcomes in co-infected patients with treatment limiting severe cutaneous adverse reactions TI - Long-term HIV and tuberculosis outcomes in co-infected patients with treatment limiting severe cutaneous adverse reactions UR - http://hdl.handle.net/11427/40194 ER - | en_ZA |
| dc.identifier.uri | http://hdl.handle.net/11427/40194 | |
| dc.identifier.vancouvercitation | Veenstra S. Long-term HIV and tuberculosis outcomes in co-infected patients with treatment limiting severe cutaneous adverse reactions. []. ,Faculty of Health Sciences ,Department of Medicine, 2023 [cited yyyy month dd]. Available from: http://hdl.handle.net/11427/40194 | en_ZA |
| dc.language.rfc3066 | Eng | |
| dc.publisher.department | Department of Medicine | |
| dc.publisher.faculty | Faculty of Health Sciences | |
| dc.subject | Internal Medicine | |
| dc.title | Long-term HIV and tuberculosis outcomes in co-infected patients with treatment limiting severe cutaneous adverse reactions | |
| dc.type | Thesis / Dissertation | |
| dc.type.qualificationlevel | Masters | |
| dc.type.qualificationlevel | MMed |