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Incidence and predictors of mortality and the effect of tuberculosis immune reconstitution inflammatory syndrome in a cohort of TB/HIV patients commencing antiretroviral therapy

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dc.contributor.author Worodria, W.
dc.contributor.author Massinga-Loembe, M.
dc.contributor.author Mazakpwe, D.
dc.contributor.author Luzinda, K.
dc.contributor.author Menten, J.
dc.contributor.author van Leth, F.
dc.contributor.author Mayanja-Kizza, H.
dc.contributor.author Kestens, L.
dc.contributor.author Mugerwa, R.
dc.contributor.author Reiss, P.
dc.contributor.author Colebunders, R.
dc.date.accessioned 2011-08-30T14:07:35Z
dc.date.available 2011-08-30T14:07:35Z
dc.date.issued 2011
dc.identifier.issn 1525-4135
dc.identifier.doi http://dx.doi.org/10.1097/QAI.0b013e3182255dc2
dc.identifier.other ITG-M2B
dc.identifier.other ITG-I5A
dc.identifier.other ITG-M8A
dc.identifier.other ITG-CLA
dc.identifier.other MULTI
dc.identifier.other U-IMMUN
dc.identifier.other INTER
dc.identifier.other U-CTU
dc.identifier.other CLINIC
dc.identifier.other U-HIVCLI
dc.identifier.other JIF
dc.identifier.other DOI
dc.identifier.other UPD37
dc.identifier.uri http://hdl.handle.net/10390/6667
dc.description.abstract BACKGROUND:: Tuberculosis-HIV (TB-HIV) co-infection remains an important cause of mortality in antiretroviral therapy (ART) programmes. In a cohort of TB-HIV co-infected patients starting ART we examined the incidence and predictors of early mortality. METHODS:: Consecutive TB-HIV co-infected patients eligible for ART were enrolled in a cohort study at the Mulago National Tuberculosis and Leprosy Programme clinic in Kampala, Uganda. Predictors of mortality were assessed using Cox proportional hazards analysis. RESULTS:: Three hundred and two patients (median CD4 count 53 cells/muL (interquartile range, 20-134)) were enrolled. Fifty three patients died, 36 (68%) of these died within the first 6 months of TB diagnosis. Male sex (HR, 2.19; 95% CI, 1.19-4.03; p=0.011), anergy to tuberculin skin test (HR 2.59 (1.10-6.12); p=0.030), a positive serum cryptococcal antigen (serum CrAG) result at enrollment (HR, 4.27; 95% CI, 1.50-12.13; p=0.006) and no ART use (HR, 4.63; 95% CI, 2. 37-9.03; p=<0.001) were independent predictors of mortality by multivariate analysis. Six (10%) patients with TB-immune reconstitution inflammatory syndrome died and in most an alternative contributing cause of death was identified. CONCLUSION:: Mortality among these TB-HIV co-infected patients was high particularly when presenting with advanced HIV disease and not starting ART, reinforcing the need for timely and joint treatment for both infections. Screening for a concomitant cryptococcal infection and antifungal treatment for patients with cryptococcal antigenemia may further improve clinical outcome. en
dc.language English en
dc.subject Viral diseases en
dc.subject HIV en
dc.subject AIDS en
dc.subject Co-infections en
dc.subject Bacterial diseases en
dc.subject Tuberculosis en
dc.subject Mycobacterium tuberculosis en
dc.subject Immune reconstitution inflammatory syndrome (IRIS) en
dc.subject IRIS en
dc.subject Incidence en
dc.subject HAART en
dc.subject Antiretrovirals en
dc.subject Predictors en
dc.subject Mortality en
dc.subject Tuberculin testing en
dc.subject Cryptococcus en
dc.subject Health impact en
dc.subject Uganda en
dc.subject Africa, East en
dc.title Incidence and predictors of mortality and the effect of tuberculosis immune reconstitution inflammatory syndrome in a cohort of TB/HIV patients commencing antiretroviral therapy en
dc.type Article en
dc.citation.issue 1 en
dc.citation.jtitle Journal of Acquired Immune Deficiency Syndromes en
dc.citation.volume 58 en
dc.citation.pages 32-37 en
dc.identifier.pmid http://www.ncbi.nlm.nih.gov/pubmed/21654499
dc.citation.jabbreviation J Acquir Immune Defic Syndr en


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