Antiretroviral Treatment-Associated Tuberculosis in a Prospective Cohort of HIV-Infected Patients Starting ART
Commencement of antiretroviral treatment (ART) in severely immunosuppressed HIV-infected persons is associated with unmasking of subclinical disease. The subset of patients that are diagnosed with tuberculosis (TB) disease while on ART have been classified as ART-associated TB. Few studies have repo...
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| Format: | Article |
| Language: | English |
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Wiley
2011-01-01
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| Series: | Clinical and Developmental Immunology |
| Online Access: | http://dx.doi.org/10.1155/2011/758350 |
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| author | William Worodria Marguerite Massinga-Loembe Harriet Mayanja-Kizza Jane Namaganda Andrew Kambugu Yukari C. Manabe Luc Kestens Robert Colebunders |
| author_facet | William Worodria Marguerite Massinga-Loembe Harriet Mayanja-Kizza Jane Namaganda Andrew Kambugu Yukari C. Manabe Luc Kestens Robert Colebunders |
| author_sort | William Worodria |
| collection | DOAJ |
| description | Commencement of antiretroviral treatment (ART) in severely immunosuppressed HIV-infected persons is associated with unmasking of subclinical disease. The subset of patients that are diagnosed with tuberculosis (TB) disease while on ART have been classified as ART-associated TB. Few studies have reported the incidence of ART-associated TB and unmasking TB-IRIS according to the International Network for the Study of HIV-Associated IRIS (INSHI) consensus definition. To determine the incidence and predictors of ART-associated TB, we screened 219 patients commencing ART at the Infectious Diseases Clinic in Kampala, Uganda for TB by symptoms, sputum microscopy, and chest X-rays and followed them for one year. Fourteen (6.4%) patients were diagnosed with TB during followup. Eight (3.8%) patients had ART-associated TB (incidence rate of 4.3 per 100 person years); of these, three patients fulfilled INSHI criteria for unmasking TB-associated IRIS (incidence rate of 1.6 per 100 person years). A body mass index of less than 18.5 kg/m2 BMI (HR 5.85 95% CI 1.24–27.46, P=.025) and a C-reactive protein greater than 5 mg/L (HR 8.23 95% CI 1.36–38.33, P=.020) were risk factors for ART-associated TB at multivariate analysis. In conclusion, with systematic TB screening (including culture and chest X-ray), the incidence of ART-associated TB is relatively low in settings with high HIV and TB prevalence. |
| format | Article |
| id | doaj-art-02ea2fb18f644de68746b9c089f3c1c0 |
| institution | Kabale University |
| issn | 1740-2522 1740-2530 |
| language | English |
| publishDate | 2011-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Clinical and Developmental Immunology |
| spelling | doaj-art-02ea2fb18f644de68746b9c089f3c1c02025-02-03T01:24:00ZengWileyClinical and Developmental Immunology1740-25221740-25302011-01-01201110.1155/2011/758350758350Antiretroviral Treatment-Associated Tuberculosis in a Prospective Cohort of HIV-Infected Patients Starting ARTWilliam Worodria0Marguerite Massinga-Loembe1Harriet Mayanja-Kizza2Jane Namaganda3Andrew Kambugu4Yukari C. Manabe5Luc Kestens6Robert Colebunders7Department of Medicine, Mulago Hospital, College of Health Sciences, Makerere University, P.O. Box 7051, Kampala, UgandaInstitute of Tropical Medicine, 2000 Antwerpen, BelgiumDepartment of Medicine, Mulago Hospital, College of Health Sciences, Makerere University, P.O. Box 7051, Kampala, UgandaInfectious Disease Institute, College of Health Sciences, Makerere University, Kampala, UgandaInfectious Disease Institute, College of Health Sciences, Makerere University, Kampala, UgandaInfectious Diseases Network for Treatment and Research in Africa (INTERACT), Makerere University, Kampala, UgandaUniversity of Antwerp, 2020 Antwerpen, BelgiumUniversity of Antwerp, 2020 Antwerpen, BelgiumCommencement of antiretroviral treatment (ART) in severely immunosuppressed HIV-infected persons is associated with unmasking of subclinical disease. The subset of patients that are diagnosed with tuberculosis (TB) disease while on ART have been classified as ART-associated TB. Few studies have reported the incidence of ART-associated TB and unmasking TB-IRIS according to the International Network for the Study of HIV-Associated IRIS (INSHI) consensus definition. To determine the incidence and predictors of ART-associated TB, we screened 219 patients commencing ART at the Infectious Diseases Clinic in Kampala, Uganda for TB by symptoms, sputum microscopy, and chest X-rays and followed them for one year. Fourteen (6.4%) patients were diagnosed with TB during followup. Eight (3.8%) patients had ART-associated TB (incidence rate of 4.3 per 100 person years); of these, three patients fulfilled INSHI criteria for unmasking TB-associated IRIS (incidence rate of 1.6 per 100 person years). A body mass index of less than 18.5 kg/m2 BMI (HR 5.85 95% CI 1.24–27.46, P=.025) and a C-reactive protein greater than 5 mg/L (HR 8.23 95% CI 1.36–38.33, P=.020) were risk factors for ART-associated TB at multivariate analysis. In conclusion, with systematic TB screening (including culture and chest X-ray), the incidence of ART-associated TB is relatively low in settings with high HIV and TB prevalence.http://dx.doi.org/10.1155/2011/758350 |
| spellingShingle | William Worodria Marguerite Massinga-Loembe Harriet Mayanja-Kizza Jane Namaganda Andrew Kambugu Yukari C. Manabe Luc Kestens Robert Colebunders Antiretroviral Treatment-Associated Tuberculosis in a Prospective Cohort of HIV-Infected Patients Starting ART Clinical and Developmental Immunology |
| title | Antiretroviral Treatment-Associated Tuberculosis in a Prospective Cohort of HIV-Infected Patients Starting ART |
| title_full | Antiretroviral Treatment-Associated Tuberculosis in a Prospective Cohort of HIV-Infected Patients Starting ART |
| title_fullStr | Antiretroviral Treatment-Associated Tuberculosis in a Prospective Cohort of HIV-Infected Patients Starting ART |
| title_full_unstemmed | Antiretroviral Treatment-Associated Tuberculosis in a Prospective Cohort of HIV-Infected Patients Starting ART |
| title_short | Antiretroviral Treatment-Associated Tuberculosis in a Prospective Cohort of HIV-Infected Patients Starting ART |
| title_sort | antiretroviral treatment associated tuberculosis in a prospective cohort of hiv infected patients starting art |
| url | http://dx.doi.org/10.1155/2011/758350 |
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