Impact of tuberculosis on mortality among HIV-infected patients receiving antiretroviral therapy in Uganda: a prospective cohort analysis
Identifieur interne : 002679 ( Main/Exploration ); précédent : 002678; suivant : 002680Impact of tuberculosis on mortality among HIV-infected patients receiving antiretroviral therapy in Uganda: a prospective cohort analysis
Auteurs : Rong Chu [Canada] ; Edward J. Mills [Canada] ; Joseph Beyene [Canada] ; Eleanor Pullenayegum [Canada] ; Celestin Bakanda [Ouganda] ; Jean B. Nachega [Afrique du Sud, États-Unis] ; P J Devereaux [Canada] ; Lehana Thabane [Canada]Source :
- AIDS Research and Therapy [ 1742-6405 ] ; 2013.
Abstract
Tuberculosis (TB) disease affects survival among HIV co-infected patients on antiretroviral therapy (ART). Yet, the magnitude of TB disease on mortality is poorly understood.
Using a prospective cohort of 22,477 adult patients who initiated ART between August 2000 and June 2009 in Uganda, we assessed the effect of active pulmonary TB disease at the initiation of ART on all-cause mortality using a Cox proportional hazards model. Propensity score (PS) matching was used to control for potential confounding. Stratification and covariate adjustment for PS and not PS-based multivariable Cox models were also performed.
A total of 1,609 (7.52%) patients had active pulmonary TB at the start of ART. TB patients had higher proportions of being male, suffering from AIDS-defining illnesses, having World Health Organization (WHO) disease stage III or IV, and having lower CD4 cell counts at baseline (p < 0.001). The percentages of death during follow-up were 10.47% and 6.38% for patients with and without TB, respectively. The hazard ratio (HR) for mortality comparing TB to non-TB patients using 1,686 PS-matched pairs was 1.37 (95% confidence interval [CI]: 1.08 – 1.75), less marked than the crude estimate (HR = 1.74, 95% CI: 1.49 – 2.04). The other PS-based methods and not PS-based multivariable Cox model produced similar results.
After controlling for important confounding variables, HIV patients who had TB at the initiation of ART in Uganda had an approximate 37% increased hazard of overall mortality relative to non-TB patients.
Url:
DOI: 10.1186/1742-6405-10-19
PubMed: 23849301
PubMed Central: 3716897
Affiliations:
- Afrique du Sud, Canada, Ouganda, États-Unis
- Maryland, Ontario
- Hamilton (Ontario)
- Université McMaster
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Unit, 3rd Floor Martha, Room H325, St Joseph’s Healthcare Hamilton, 50 Charlton Avenue East, Hamilton, ON L8N 4A6, Canada</nlm:aff><country xml:lang="fr">Canada</country><wicri:regionArea>Biostatistics Unit, 3rd Floor Martha, Room H325, St Joseph’s Healthcare Hamilton, 50 Charlton Avenue East, Hamilton, ON L8N 4A6</wicri:regionArea><wicri:noRegion>ON L8N 4A6</wicri:noRegion></affiliation></author><author><name sortKey="Mills, Edward J" sort="Mills, Edward J" uniqKey="Mills E" first="Edward J" last="Mills">Edward J. Mills</name><affiliation wicri:level="4"><nlm:aff id="I1">Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada</nlm:aff><country xml:lang="fr">Canada</country><wicri:regionArea>Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton</wicri:regionArea><orgName type="university">Université McMaster</orgName><placeName><settlement type="city">Hamilton (Ontario)</settlement><region type="state">Ontario</region></placeName></affiliation><affiliation wicri:level="1"><nlm:aff id="I3">Faculty of Health Sciences, University of Ottawa, Ottawa, Canada</nlm:aff><country xml:lang="fr">Canada</country><wicri:regionArea>Faculty of Health Sciences, University of Ottawa, Ottawa</wicri:regionArea><wicri:noRegion>Ottawa</wicri:noRegion></affiliation></author><author><name sortKey="Beyene, Joseph" sort="Beyene, Joseph" uniqKey="Beyene J" first="Joseph" last="Beyene">Joseph Beyene</name><affiliation wicri:level="4"><nlm:aff id="I1">Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada</nlm:aff><country xml:lang="fr">Canada</country><wicri:regionArea>Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton</wicri:regionArea><orgName type="university">Université McMaster</orgName><placeName><settlement type="city">Hamilton (Ontario)</settlement><region type="state">Ontario</region></placeName></affiliation></author><author><name sortKey="Pullenayegum, Eleanor" sort="Pullenayegum, Eleanor" uniqKey="Pullenayegum E" first="Eleanor" last="Pullenayegum">Eleanor Pullenayegum</name><affiliation wicri:level="4"><nlm:aff id="I1">Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada</nlm:aff><country xml:lang="fr">Canada</country><wicri:regionArea>Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton</wicri:regionArea><orgName type="university">Université McMaster</orgName><placeName><settlement type="city">Hamilton (Ontario)</settlement><region type="state">Ontario</region></placeName></affiliation><affiliation wicri:level="1"><nlm:aff id="I2">Biostatistics Unit, 3rd Floor Martha, Room H325, St Joseph’s Healthcare Hamilton, 50 Charlton Avenue East, Hamilton, ON L8N 4A6, Canada</nlm:aff><country xml:lang="fr">Canada</country><wicri:regionArea>Biostatistics Unit, 3rd Floor Martha, Room H325, St Joseph’s Healthcare Hamilton, 50 Charlton Avenue East, Hamilton, ON L8N 4A6</wicri:regionArea><wicri:noRegion>ON L8N 4A6</wicri:noRegion></affiliation></author><author><name sortKey="Bakanda, Celestin" sort="Bakanda, Celestin" uniqKey="Bakanda C" first="Celestin" last="Bakanda">Celestin Bakanda</name><affiliation wicri:level="1"><nlm:aff id="I4">The AIDS Support Organization (TASO), Kampala, Uganda</nlm:aff><country xml:lang="fr">Ouganda</country><wicri:regionArea>The AIDS Support Organization (TASO), Kampala</wicri:regionArea><wicri:noRegion>Kampala</wicri:noRegion></affiliation></author><author><name sortKey="Nachega, Jean B" sort="Nachega, Jean B" uniqKey="Nachega J" first="Jean B" last="Nachega">Jean B. Nachega</name><affiliation wicri:level="1"><nlm:aff id="I5">Department of Medicine and Centre for Infectious Diseases, Stellenbosch University, Cape Town, South Africa</nlm:aff><country xml:lang="fr">Afrique du Sud</country><wicri:regionArea>Department of Medicine and Centre for Infectious Diseases, Stellenbosch University, Cape Town</wicri:regionArea><wicri:noRegion>Cape Town</wicri:noRegion></affiliation><affiliation wicri:level="2"><nlm:aff id="I6">Departments of Epidemiology and International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Departments of Epidemiology and International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD</wicri:regionArea><placeName><region type="state">Maryland</region></placeName></affiliation></author><author><name sortKey="Devereaux, P J" sort="Devereaux, P J" uniqKey="Devereaux P" first="P J" last="Devereaux">P J Devereaux</name><affiliation wicri:level="4"><nlm:aff id="I1">Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada</nlm:aff><country xml:lang="fr">Canada</country><wicri:regionArea>Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton</wicri:regionArea><orgName type="university">Université McMaster</orgName><placeName><settlement type="city">Hamilton (Ontario)</settlement><region type="state">Ontario</region></placeName></affiliation><affiliation wicri:level="1"><nlm:aff id="I7">Hamilton Health Sciences, Population Health Research Institute, Hamilton, Canada</nlm:aff><country xml:lang="fr">Canada</country><wicri:regionArea>Hamilton Health Sciences, Population Health Research Institute, Hamilton</wicri:regionArea><wicri:noRegion>Hamilton</wicri:noRegion></affiliation></author><author><name sortKey="Thabane, Lehana" sort="Thabane, Lehana" uniqKey="Thabane L" first="Lehana" last="Thabane">Lehana Thabane</name><affiliation wicri:level="4"><nlm:aff id="I1">Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada</nlm:aff><country xml:lang="fr">Canada</country><wicri:regionArea>Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton</wicri:regionArea><orgName type="university">Université McMaster</orgName><placeName><settlement type="city">Hamilton (Ontario)</settlement><region type="state">Ontario</region></placeName></affiliation><affiliation wicri:level="1"><nlm:aff id="I2">Biostatistics Unit, 3rd Floor Martha, Room H325, St Joseph’s Healthcare Hamilton, 50 Charlton Avenue East, Hamilton, ON L8N 4A6, Canada</nlm:aff><country xml:lang="fr">Canada</country><wicri:regionArea>Biostatistics Unit, 3rd Floor Martha, Room H325, St Joseph’s Healthcare Hamilton, 50 Charlton Avenue East, Hamilton, ON L8N 4A6</wicri:regionArea><wicri:noRegion>ON L8N 4A6</wicri:noRegion></affiliation></author></analytic><series><title level="j">AIDS Research and Therapy</title><idno type="eISSN">1742-6405</idno><imprint><date when="2013">2013</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Background</title><p>Tuberculosis (TB) disease affects survival among HIV co-infected patients on antiretroviral therapy (ART). Yet, the magnitude of TB disease on mortality is poorly understood.</p></sec><sec><title>Methods</title><p>Using a prospective cohort of 22,477 adult patients who initiated ART between August 2000 and June 2009 in Uganda, we assessed the effect of active pulmonary TB disease at the initiation of ART on all-cause mortality using a Cox proportional hazards model. Propensity score (PS) matching was used to control for potential confounding. Stratification and covariate adjustment for PS and not PS-based multivariable Cox models were also performed.</p></sec><sec><title>Results</title><p>A total of 1,609 (7.52%) patients had active pulmonary TB at the start of ART. TB patients had higher proportions of being male, suffering from AIDS-defining illnesses, having World Health Organization (WHO) disease stage III or IV, and having lower CD4 cell counts at baseline (p < 0.001). The percentages of death during follow-up were 10.47% and 6.38% for patients with and without TB, respectively. The hazard ratio (HR) for mortality comparing TB to non-TB patients using 1,686 PS-matched pairs was 1.37 (95% confidence interval [CI]: 1.08 – 1.75), less marked than the crude estimate (HR = 1.74, 95% CI: 1.49 – 2.04). The other PS-based methods and not PS-based multivariable Cox model produced similar results.</p></sec><sec><title>Conclusions</title><p>After controlling for important confounding variables, HIV patients who had TB at the initiation of ART in Uganda had an approximate 37% increased hazard of overall mortality relative to non-TB patients.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Selwyn, Pa" uniqKey="Selwyn P">PA Selwyn</name></author><author><name sortKey="Hartel, D" uniqKey="Hartel D">D Hartel</name></author><author><name sortKey="Lewis, Va" uniqKey="Lewis V">VA Lewis</name></author><author><name sortKey="Schoenbaum, Ee" uniqKey="Schoenbaum E">EE Schoenbaum</name></author><author><name sortKey="Vermund, Sh" uniqKey="Vermund S">SH Vermund</name></author><author><name sortKey="Klein, Rs" uniqKey="Klein R">RS Klein</name></author><author><name sortKey="Walker, At" uniqKey="Walker A">AT 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sortKey="Pawinski, R" uniqKey="Pawinski R">R Pawinski</name></author><author><name sortKey="Govender, T" uniqKey="Govender T">T Govender</name></author><author><name sortKey="Lalloo, U" uniqKey="Lalloo U">U Lalloo</name></author><author><name sortKey="Zeller, K" uniqKey="Zeller K">K Zeller</name></author><author><name sortKey="Andrews, J" uniqKey="Andrews J">J Andrews</name></author><author><name sortKey="Friedland, G" uniqKey="Friedland G">G Friedland</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Stukel, Ta" uniqKey="Stukel T">TA Stukel</name></author><author><name sortKey="Fisher, Es" uniqKey="Fisher E">ES Fisher</name></author><author><name sortKey="Wennberg, De" uniqKey="Wennberg D">DE Wennberg</name></author><author><name sortKey="Alter, Da" uniqKey="Alter D">DA Alter</name></author><author><name sortKey="Gottlieb, Dj" uniqKey="Gottlieb D">DJ Gottlieb</name></author><author><name sortKey="Vermeulen, Mj" uniqKey="Vermeulen M">MJ Vermeulen</name></author></analytic></biblStruct><biblStruct></biblStruct></listBibl></div1></back></TEI><affiliations><list><country><li>Afrique du Sud</li><li>Canada</li><li>Ouganda</li><li>États-Unis</li></country><region><li>Maryland</li><li>Ontario</li></region><settlement><li>Hamilton (Ontario)</li></settlement><orgName><li>Université McMaster</li></orgName></list><tree><country name="Canada"><region name="Ontario"><name sortKey="Chu, Rong" sort="Chu, Rong" uniqKey="Chu R" first="Rong" last="Chu">Rong Chu</name></region><name sortKey="Beyene, Joseph" sort="Beyene, Joseph" uniqKey="Beyene J" first="Joseph" last="Beyene">Joseph Beyene</name><name sortKey="Chu, Rong" sort="Chu, Rong" uniqKey="Chu R" first="Rong" last="Chu">Rong Chu</name><name sortKey="Devereaux, P J" sort="Devereaux, P J" uniqKey="Devereaux P" first="P J" last="Devereaux">P J Devereaux</name><name sortKey="Devereaux, P J" sort="Devereaux, P J" uniqKey="Devereaux P" first="P J" last="Devereaux">P J Devereaux</name><name sortKey="Mills, Edward J" sort="Mills, Edward J" uniqKey="Mills E" first="Edward J" last="Mills">Edward J. Mills</name><name sortKey="Mills, Edward J" sort="Mills, Edward J" uniqKey="Mills E" first="Edward J" last="Mills">Edward J. Mills</name><name sortKey="Pullenayegum, Eleanor" sort="Pullenayegum, Eleanor" uniqKey="Pullenayegum E" first="Eleanor" last="Pullenayegum">Eleanor Pullenayegum</name><name sortKey="Pullenayegum, Eleanor" sort="Pullenayegum, Eleanor" uniqKey="Pullenayegum E" first="Eleanor" last="Pullenayegum">Eleanor Pullenayegum</name><name sortKey="Thabane, Lehana" sort="Thabane, Lehana" uniqKey="Thabane L" first="Lehana" last="Thabane">Lehana Thabane</name><name sortKey="Thabane, Lehana" sort="Thabane, Lehana" uniqKey="Thabane L" first="Lehana" last="Thabane">Lehana Thabane</name></country><country name="Ouganda"><noRegion><name sortKey="Bakanda, Celestin" sort="Bakanda, Celestin" uniqKey="Bakanda C" first="Celestin" last="Bakanda">Celestin Bakanda</name></noRegion></country><country name="Afrique du Sud"><noRegion><name sortKey="Nachega, Jean B" sort="Nachega, Jean B" uniqKey="Nachega J" first="Jean B" last="Nachega">Jean B. Nachega</name></noRegion></country><country name="États-Unis"><region name="Maryland"><name sortKey="Nachega, Jean B" sort="Nachega, Jean B" uniqKey="Nachega J" first="Jean B" last="Nachega">Jean B. Nachega</name></region></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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