Clinical deterioration during antituberculosis treatment in Africa: incidence, causes and risk factors.
Identifieur interne : 000587 ( PubMed/Curation ); précédent : 000586; suivant : 000588Clinical deterioration during antituberculosis treatment in Africa: incidence, causes and risk factors.
Auteurs : Dominique J. Pepper [Afrique du Sud] ; Suzaan Marais ; Robert J. Wilkinson ; Feriyl Bhaijee ; Gary Maartens ; Helen Mcilleron ; Virginia De Azevedo ; Helen Cox ; Cheryl Mcdermid ; Simiso Sokhela ; Janisha Patel ; Graeme MeintjesSource :
- BMC infectious diseases [ 1471-2334 ] ; 2010.
Descripteurs français
- KwdFr :
- Afrique, Agents antiVIH (usage thérapeutique), Antituberculeux (usage thérapeutique), Comorbidité, Facteurs de risque, Humains, Incidence, Infections à VIH (), Infections à VIH (anatomopathologie), Infections à VIH (mortalité), Infections à VIH (virologie), Numération des lymphocytes CD4, Thérapie antirétrovirale hautement active, Tuberculose (anatomopathologie), Tuberculose (mortalité), Tuberculose (traitement médicamenteux), VIH-1 (Virus de l'Immunodéficience Humaine de type 1) (isolement et purification), Échec thérapeutique, Études de cohortes, Études prospectives.
- MESH :
- anatomopathologie : Infections à VIH, Tuberculose.
- isolement et purification : VIH-1 (Virus de l'Immunodéficience Humaine de type 1).
- mortalité : Infections à VIH, Tuberculose.
- traitement médicamenteux : Tuberculose.
- usage thérapeutique : Agents antiVIH, Antituberculeux.
- virologie : Infections à VIH.
- Afrique, Comorbidité, Facteurs de risque, Humains, Incidence, Infections à VIH, Numération des lymphocytes CD4, Thérapie antirétrovirale hautement active, Échec thérapeutique, Études de cohortes, Études prospectives.
English descriptors
- KwdEn :
- Africa, Anti-HIV Agents (therapeutic use), Antiretroviral Therapy, Highly Active, Antitubercular Agents (therapeutic use), CD4 Lymphocyte Count, Cohort Studies, Comorbidity, HIV Infections (complications), HIV Infections (mortality), HIV Infections (pathology), HIV Infections (virology), HIV-1 (isolation & purification), Humans, Incidence, Prospective Studies, Risk Factors, Treatment Failure, Tuberculosis (drug therapy), Tuberculosis (mortality), Tuberculosis (pathology).
- MESH :
- chemical , therapeutic use : Anti-HIV Agents, Antitubercular Agents.
- geographic : Africa.
- complications : HIV Infections.
- drug therapy : Tuberculosis.
- isolation & purification : HIV-1.
- mortality : HIV Infections, Tuberculosis.
- pathology : HIV Infections, Tuberculosis.
- virology : HIV Infections.
- Antiretroviral Therapy, Highly Active, CD4 Lymphocyte Count, Cohort Studies, Comorbidity, Humans, Incidence, Prospective Studies, Risk Factors, Treatment Failure.
Abstract
HIV-1 and Mycobacterium tuberculosis cause substantial morbidity and mortality. Despite the availability of antiretroviral and antituberculosis treatment in Africa, clinical deterioration during antituberculosis treatment remains a frequent reason for hospital admission. We therefore determined the incidence, causes and risk factors for clinical deterioration.
DOI: 10.1186/1471-2334-10-83
PubMed: 20353569
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pubmed:20353569Le document en format XML
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<front><div type="abstract" xml:lang="en">HIV-1 and Mycobacterium tuberculosis cause substantial morbidity and mortality. Despite the availability of antiretroviral and antituberculosis treatment in Africa, clinical deterioration during antituberculosis treatment remains a frequent reason for hospital admission. We therefore determined the incidence, causes and risk factors for clinical deterioration.</div>
</front>
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<Title>BMC infectious diseases</Title>
<ISOAbbreviation>BMC Infect. Dis.</ISOAbbreviation>
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<ArticleTitle>Clinical deterioration during antituberculosis treatment in Africa: incidence, causes and risk factors.</ArticleTitle>
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<Abstract><AbstractText Label="BACKGROUND" NlmCategory="BACKGROUND">HIV-1 and Mycobacterium tuberculosis cause substantial morbidity and mortality. Despite the availability of antiretroviral and antituberculosis treatment in Africa, clinical deterioration during antituberculosis treatment remains a frequent reason for hospital admission. We therefore determined the incidence, causes and risk factors for clinical deterioration.</AbstractText>
<AbstractText Label="METHODS" NlmCategory="METHODS">Prospective cohort study of 292 adults who initiated antituberculosis treatment during a 3-month period. We evaluated those with clinical deterioration over the following 24 weeks of treatment.</AbstractText>
<AbstractText Label="RESULTS" NlmCategory="RESULTS">Seventy-one percent (209/292) of patients were HIV-1 infected (median CD4+: 129 cells/microL [IQR:62-277]). At tuberculosis diagnosis, 23% (34/145) of HIV-1 infected patients qualifying for antiretroviral treatment (ART) were receiving ART; 6 months later, 75% (109/145) had received ART. Within 24 weeks of initiating antituberculosis treatment, 40% (117/292) of patients experienced clinical deterioration due to co-morbid illness (n = 70), tuberculosis related illness (n = 47), non AIDS-defining HIV-1 related infection (n = 25) and AIDS-defining illness (n = 21). Using HIV-1 uninfected patients as the referent group, HIV-1 infected patients had an increasing risk of clinical deterioration as CD4+ counts decreased [CD4+>350 cells/microL: RR = 1.4, 95% CI = 0.7-2.9; CD4+:200-350 cells/microL: RR = 2.0, 95% CI = 1.1-3.6; CD4+<200 cells/microL: RR = 3.0, 95% CI = 1.9-4.7]. During follow-up, 26% (30/117) of patients with clinical deterioration required hospital admission and 15% (17/117) died. Fifteen deaths were in HIV-1 infected patients with a CD4+<200 cells/microL.</AbstractText>
<AbstractText Label="CONCLUSIONS" NlmCategory="CONCLUSIONS">In multivariate analysis, HIV-1 infection and a low CD4+ count at tuberculosis diagnosis were significant risk factors for clinical deterioration and death. The initiation of ART at a CD4+ count of <350 cells/microL will likely reduce the high burden of clinical deterioration.</AbstractText>
</Abstract>
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<ForeName>Dominique J</ForeName>
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<Author ValidYN="Y"><LastName>Marais</LastName>
<ForeName>Suzaan</ForeName>
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<Author ValidYN="Y"><LastName>Wilkinson</LastName>
<ForeName>Robert J</ForeName>
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<Author ValidYN="Y"><LastName>Bhaijee</LastName>
<ForeName>Feriyl</ForeName>
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<Author ValidYN="Y"><LastName>Maartens</LastName>
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<Author ValidYN="Y"><LastName>Sokhela</LastName>
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<ForeName>Janisha</ForeName>
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<Author ValidYN="Y"><LastName>Meintjes</LastName>
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</CommentsCorrections>
<CommentsCorrections RefType="Cites"><RefSource>AIDS Res Hum Retroviruses. 2002 Jan 20;18(2):89-94</RefSource>
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<QualifierName UI="Q000473" MajorTopicYN="Y">pathology</QualifierName>
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<MeshHeading><DescriptorName UI="D017211" MajorTopicYN="N">Treatment Failure</DescriptorName>
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<MeshHeading><DescriptorName UI="D014376" MajorTopicYN="N">Tuberculosis</DescriptorName>
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<QualifierName UI="Q000473" MajorTopicYN="Y">pathology</QualifierName>
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<Month>11</Month>
<Day>13</Day>
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