The predictive value of current haemoglobin levels for incident tuberculosis and/or mortality during long-term antiretroviral therapy in South Africa: a cohort study

dc.contributor.authorKerkhoff, Andrewen_ZA
dc.contributor.authorWood, Robinen_ZA
dc.contributor.authorCobelens, Franken_ZA
dc.contributor.authorGupta-Wright, Ankuren_ZA
dc.contributor.authorBekker, Linda-Gailen_ZA
dc.contributor.authorLawn, Stephenen_ZA
dc.date.accessioned2015-12-07T08:46:44Z
dc.date.available2015-12-07T08:46:44Z
dc.date.issued2015en_ZA
dc.description.abstractBACKGROUND: Low haemoglobin concentrations may be predictive of incident tuberculosis (TB) and death in HIV-infected patients receiving antiretroviral therapy (ART), but data are limited and inconsistent. We examined these relationships retrospectively in a long-term South African ART cohort with multiple time-updated haemoglobin measurements. METHODS: Prospectively collected clinical data on patients receiving ART for up to 8years in a community-based cohort were analysed. Time-updated haemoglobin concentrations, CD4 counts and HIV viral loads were recorded, and TB diagnoses and deaths from all causes were ascertained. Anaemia severity was classified using World Health Organization criteria. TB incidence and mortality rates were calculated and Poisson regression models were used to identify independent predictors of incident TB and mortality, respectively. RESULTS: During a median follow-up of 5.0years (IQR, 2.5-5.8) of 1,521 patients, 476 cases of incident TB and 192 deaths occurred during 6,459 person-years (PYs) of follow-up. TB incidence rates were strongly associated with time-updated anaemia severity; those without anaemia had a rate of 4.4 (95%CI, 3.8-5.1) cases/100 PYs compared to 10.0 (95%CI, 8.3-12.1), 26.6 (95%CI, 22.5-31.7) and 87.8 (95%CI, 57.0-138.2) cases/100 PYs in those with mild, moderate and severe anaemia, respectively. Similarly, mortality rates in those with no anaemia or mild, moderate and severe time-updated anaemia were 1.1 (95%CI, 0.8-1.5), 3.5 (95%CI, 2.7-4.8), 11.8 (95%CI, 9.5-14.8) and 28.2 (95%CI, 16.5-51.5) cases/100 PYs, respectively. Moderate and severe anaemia (time-updated) during ART were the strongest independent predictors for incident TB (adjusted IRR=3.8 [95%CI, 3.0-4.8] and 8.2 [95%CI, 5.3-12.7], respectively) and for mortality (adjusted IRR=6.0 [95%CI, 3.9-9.2] and adjusted IRR=8.0 [95%CI, 3.9-16.4], respectively). CONCLUSIONS: Increasing severity of anaemia was associated with exceptionally high rates of both incident TB and mortality during long-term ART. Patients receiving ART who have moderate or severe anaemia should be prioritized for TB screening using microbiological assays and may require adjunctive clinical interventions.en_ZA
dc.identifier.apacitationKerkhoff, A., Wood, R., Cobelens, F., Gupta-Wright, A., Bekker, L., & Lawn, S. (2015). The predictive value of current haemoglobin levels for incident tuberculosis and/or mortality during long-term antiretroviral therapy in South Africa: a cohort study. <i>BMC Medicine</i>, http://hdl.handle.net/11427/15626en_ZA
dc.identifier.chicagocitationKerkhoff, Andrew, Robin Wood, Frank Cobelens, Ankur Gupta-Wright, Linda-Gail Bekker, and Stephen Lawn "The predictive value of current haemoglobin levels for incident tuberculosis and/or mortality during long-term antiretroviral therapy in South Africa: a cohort study." <i>BMC Medicine</i> (2015) http://hdl.handle.net/11427/15626en_ZA
dc.identifier.citationKerkhoff, A. D., Wood, R., Cobelens, F. G., Gupta-Wright, A., Bekker, L. G., & Lawn, S. D. (2015). The predictive value of current haemoglobin levels for incident tuberculosis and/or mortality during long-term antiretroviral therapy in South Africa: a cohort study. BMC medicine, 13(1), 70.en_ZA
dc.identifier.ris TY - Journal Article AU - Kerkhoff, Andrew AU - Wood, Robin AU - Cobelens, Frank AU - Gupta-Wright, Ankur AU - Bekker, Linda-Gail AU - Lawn, Stephen AB - BACKGROUND: Low haemoglobin concentrations may be predictive of incident tuberculosis (TB) and death in HIV-infected patients receiving antiretroviral therapy (ART), but data are limited and inconsistent. We examined these relationships retrospectively in a long-term South African ART cohort with multiple time-updated haemoglobin measurements. METHODS: Prospectively collected clinical data on patients receiving ART for up to 8years in a community-based cohort were analysed. Time-updated haemoglobin concentrations, CD4 counts and HIV viral loads were recorded, and TB diagnoses and deaths from all causes were ascertained. Anaemia severity was classified using World Health Organization criteria. TB incidence and mortality rates were calculated and Poisson regression models were used to identify independent predictors of incident TB and mortality, respectively. RESULTS: During a median follow-up of 5.0years (IQR, 2.5-5.8) of 1,521 patients, 476 cases of incident TB and 192 deaths occurred during 6,459 person-years (PYs) of follow-up. TB incidence rates were strongly associated with time-updated anaemia severity; those without anaemia had a rate of 4.4 (95%CI, 3.8-5.1) cases/100 PYs compared to 10.0 (95%CI, 8.3-12.1), 26.6 (95%CI, 22.5-31.7) and 87.8 (95%CI, 57.0-138.2) cases/100 PYs in those with mild, moderate and severe anaemia, respectively. Similarly, mortality rates in those with no anaemia or mild, moderate and severe time-updated anaemia were 1.1 (95%CI, 0.8-1.5), 3.5 (95%CI, 2.7-4.8), 11.8 (95%CI, 9.5-14.8) and 28.2 (95%CI, 16.5-51.5) cases/100 PYs, respectively. Moderate and severe anaemia (time-updated) during ART were the strongest independent predictors for incident TB (adjusted IRR=3.8 [95%CI, 3.0-4.8] and 8.2 [95%CI, 5.3-12.7], respectively) and for mortality (adjusted IRR=6.0 [95%CI, 3.9-9.2] and adjusted IRR=8.0 [95%CI, 3.9-16.4], respectively). CONCLUSIONS: Increasing severity of anaemia was associated with exceptionally high rates of both incident TB and mortality during long-term ART. Patients receiving ART who have moderate or severe anaemia should be prioritized for TB screening using microbiological assays and may require adjunctive clinical interventions. DA - 2015 DB - OpenUCT DO - 10.1186/s12916-015-0320-9 DP - University of Cape Town J1 - BMC Medicine LK - https://open.uct.ac.za PB - University of Cape Town PY - 2015 T1 - The predictive value of current haemoglobin levels for incident tuberculosis and/or mortality during long-term antiretroviral therapy in South Africa: a cohort study TI - The predictive value of current haemoglobin levels for incident tuberculosis and/or mortality during long-term antiretroviral therapy in South Africa: a cohort study UR - http://hdl.handle.net/11427/15626 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/15626
dc.identifier.urihttp://dx.doi.org/10.1186/s12916-015-0320-9
dc.identifier.vancouvercitationKerkhoff A, Wood R, Cobelens F, Gupta-Wright A, Bekker L, Lawn S. The predictive value of current haemoglobin levels for incident tuberculosis and/or mortality during long-term antiretroviral therapy in South Africa: a cohort study. BMC Medicine. 2015; http://hdl.handle.net/11427/15626.en_ZA
dc.language.isoengen_ZA
dc.publisherBioMed Central Ltden_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 Licenseen_ZA
dc.rights.holder2015 Kerkhoff et al.; licensee BioMed Central.en_ZA
dc.rights.urihttp://creativecommons.org/licenses/by/4.0en_ZA
dc.sourceBMC Medicineen_ZA
dc.source.urihttp://www.biomedcentral.com/bmcmed/en_ZA
dc.subject.otherHIVen_ZA
dc.subject.otherAIDSen_ZA
dc.subject.otherTuberculosisen_ZA
dc.subject.otherAfricaen_ZA
dc.subject.otherAnaemiaen_ZA
dc.subject.otherAntiretroviralen_ZA
dc.subject.otherMortalityen_ZA
dc.titleThe predictive value of current haemoglobin levels for incident tuberculosis and/or mortality during long-term antiretroviral therapy in South Africa: a cohort studyen_ZA
dc.typeJournal Articleen_ZA
uct.type.filetypeText
uct.type.filetypeImage
uct.type.publicationResearchen_ZA
uct.type.resourceArticleen_ZA
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