Complications of antiretroviral therapy initiation in hospitalised patients with HIV-associated tuberculosis

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dc.contributor.authorvan der Plas, Helenen_ZA
dc.contributor.authorMeintjes, Graemeen_ZA
dc.contributor.authorSchutz, Charlotteen_ZA
dc.contributor.authorGoliath, Reneen_ZA
dc.contributor.authorMyer, Landonen_ZA
dc.contributor.authorBaatjie, Dorotheaen_ZA
dc.contributor.authorWilkinson, Robert Jen_ZA
dc.contributor.authorMaartens, Garyen_ZA
dc.contributor.authorMendelson, Marcen_ZA
dc.date.accessioned2015-12-20T16:05:16Z
dc.date.available2015-12-20T16:05:16Z
dc.date.issued2013en_ZA
dc.description.abstractBACKGROUND: HIV-associated tuberculosis is a common coinfection in Sub-Saharan Africa, which causes high morbidity and mortality. A sub-set of HIV-associated tuberculosis patients require prolonged hospital admission, during which antiretroviral therapy initiation may be required. The aim of this study was to document the causes of clinical deterioration of hospitalised patients with HIV-associated tuberculosis starting antiretroviral therapy in order to inform healthcare practice in low- to middle-income countries. METHODS: Prospective, observational cohort study of adult inpatients with HIV-associated tuberculosis starting antiretroviral therapy in a dedicated tuberculosis hospital in Cape Town, South Africa. Causes of clinical deterioration and outcome were recorded in the first 12 weeks of antiretroviral therapy. Patients with rifampicin-resistant tuberculosis were excluded. RESULTS: Between May 2009 and November 2010, 112 patients (60% female), with a median age of 32 years were enrolled. At baseline the median CD4 count was 55 cells/mm 3 (IQR 31-106) and HIV viral load 5.6 log copies/mL. All patients had significant comorbidity: 82% were bed-bound, 65% had disseminated tuberculosis and 27% had central nervous system tuberculosis. Seventy six patients (68%) developed 144 clinical events after starting antiretroviral therapy. TB-IRIS, hospital-acquired infections and significant drug toxicities occurred in 42%, 20.5% and 15% of patients respectively. A new opportunistic disease occurred in 15% of patients and a thromboembolic event in 8%. Mortality during the 12 week period was 10.6%. CONCLUSIONS: High rates of TB-IRIS, hospital-acquired infections and drug toxicities complicate the course of patients with HIV-associated tuberculosis starting antiretroviral therapy in hospital. Despite the high morbidity, mortality was relatively low. Careful clinical management and adequate resources are needed in hospitalised HIV-TB patients in the 1 st three months following ART initiation.en_ZA
dc.identifier.apacitationvan der Plas, H., Meintjes, G., Schutz, C., Goliath, R., Myer, L., Baatjie, D., ... Mendelson, M. (2013). Complications of antiretroviral therapy initiation in hospitalised patients with HIV-associated tuberculosis. <i>PLoS One</i>, http://hdl.handle.net/11427/15917en_ZA
dc.identifier.chicagocitationvan der Plas, Helen, Graeme Meintjes, Charlotte Schutz, Rene Goliath, Landon Myer, Dorothea Baatjie, Robert J Wilkinson, Gary Maartens, and Marc Mendelson "Complications of antiretroviral therapy initiation in hospitalised patients with HIV-associated tuberculosis." <i>PLoS One</i> (2013) http://hdl.handle.net/11427/15917en_ZA
dc.identifier.citationvan der Plas, H., Meintjes, G., Schutz, C., Goliath, R., Myer, L., Baatjie, D., ... & Mendelson, M. (2013). Complications of antiretroviral therapy initiation in hospitalised patients with HIV-associated tuberculosis. PloS one, 8(2), e54145. doi:10.1371/journal.pone.0054145en_ZA
dc.identifier.ris TY - Journal Article AU - van der Plas, Helen AU - Meintjes, Graeme AU - Schutz, Charlotte AU - Goliath, Rene AU - Myer, Landon AU - Baatjie, Dorothea AU - Wilkinson, Robert J AU - Maartens, Gary AU - Mendelson, Marc AB - BACKGROUND: HIV-associated tuberculosis is a common coinfection in Sub-Saharan Africa, which causes high morbidity and mortality. A sub-set of HIV-associated tuberculosis patients require prolonged hospital admission, during which antiretroviral therapy initiation may be required. The aim of this study was to document the causes of clinical deterioration of hospitalised patients with HIV-associated tuberculosis starting antiretroviral therapy in order to inform healthcare practice in low- to middle-income countries. METHODS: Prospective, observational cohort study of adult inpatients with HIV-associated tuberculosis starting antiretroviral therapy in a dedicated tuberculosis hospital in Cape Town, South Africa. Causes of clinical deterioration and outcome were recorded in the first 12 weeks of antiretroviral therapy. Patients with rifampicin-resistant tuberculosis were excluded. RESULTS: Between May 2009 and November 2010, 112 patients (60% female), with a median age of 32 years were enrolled. At baseline the median CD4 count was 55 cells/mm 3 (IQR 31-106) and HIV viral load 5.6 log copies/mL. All patients had significant comorbidity: 82% were bed-bound, 65% had disseminated tuberculosis and 27% had central nervous system tuberculosis. Seventy six patients (68%) developed 144 clinical events after starting antiretroviral therapy. TB-IRIS, hospital-acquired infections and significant drug toxicities occurred in 42%, 20.5% and 15% of patients respectively. A new opportunistic disease occurred in 15% of patients and a thromboembolic event in 8%. Mortality during the 12 week period was 10.6%. CONCLUSIONS: High rates of TB-IRIS, hospital-acquired infections and drug toxicities complicate the course of patients with HIV-associated tuberculosis starting antiretroviral therapy in hospital. Despite the high morbidity, mortality was relatively low. Careful clinical management and adequate resources are needed in hospitalised HIV-TB patients in the 1 st three months following ART initiation. DA - 2013 DB - OpenUCT DO - 10.1371/journal.pone.0054145 DP - University of Cape Town J1 - PLoS One LK - https://open.uct.ac.za PB - University of Cape Town PY - 2013 T1 - Complications of antiretroviral therapy initiation in hospitalised patients with HIV-associated tuberculosis TI - Complications of antiretroviral therapy initiation in hospitalised patients with HIV-associated tuberculosis UR - http://hdl.handle.net/11427/15917 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/15917
dc.identifier.urihttp://dx.doi.org/10.1371/journal.pone.0054145
dc.identifier.vancouvercitationvan der Plas H, Meintjes G, Schutz C, Goliath R, Myer L, Baatjie D, et al. Complications of antiretroviral therapy initiation in hospitalised patients with HIV-associated tuberculosis. PLoS One. 2013; http://hdl.handle.net/11427/15917.en_ZA
dc.language.isoengen_ZA
dc.publisherPublic Library of Scienceen_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 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 van der Plas 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.otherNosocomial infectionsen_ZA
dc.subject.otherHospitalsen_ZA
dc.subject.otherInpatientsen_ZA
dc.subject.otherExtensively drug-resistant tuberculosisen_ZA
dc.subject.otherToxicityen_ZA
dc.titleComplications of antiretroviral therapy initiation in hospitalised patients with HIV-associated tuberculosisen_ZA
dc.typeJournal Articleen_ZA
uct.type.filetypeText
uct.type.filetypeImage
uct.type.publicationResearchen_ZA
uct.type.resourceArticleen_ZA
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