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Outcome of HIV-associated tuberculosis in the era of highly active antiretroviral therapy

Dheda, K; Lampe, FC; Johnson, MA; Lipman, MC; (2004) Outcome of HIV-associated tuberculosis in the era of highly active antiretroviral therapy. JOURNAL OF INFECTIOUS DISEASES , 190 (9) 1670 - 1676.

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Abstract

Background. The benefit of highly active antiretroviral therapy (HAART) in the treatment of patients coinfected with tuberculosis ( TB) and human immunodeficiency virus (HIV) is unclear because of concerns about treatment-related complications.Methods. We compared outcomes in patients starting TB treatment during the pre-HAART era ( before 1996; n = 36) with those in patients starting treatment during the HAART era ( during or after 1996;).Results. During a median of 3.6 years of follow-up, 49 patients died or had an AIDS event. Compared with patients in the pre-HAART group, those in the HAART group had a lower risk of death ( cumulative at 4 years, 43% vs. 22%; P = .012) and of death or having an AIDS event (69% vs. 43%; P = .023). Event risk within the Pp. 012 Pp. 023 first 2 months of TB treatment was exceptionally high in patients with CD4(+) cell counts <100 cells/mm(3) and declined thereafter. HAART use during follow-up was associated with a marked reduction in event risk ( adjusted hazard ratio, 0.38 [95% confidence interval, 0.16 - 0.91]).Conclusions. HAART substantially reduces new AIDS events and death in coinfected patients. Those with a CD4(+) cell count <100 cells/mm(3) have a high event risk during the intensive phase of anti-TB treatment. These data should be taken into account when deciding to delay HAART in coinfected patients with CD4(+) cell counts < 100 cells/mm(3).

Type: Article
Title: Outcome of HIV-associated tuberculosis in the era of highly active antiretroviral therapy
Location: LONDON, ENGLAND
Keywords: HUMAN-IMMUNODEFICIENCY-VIRUS, PULMONARY TUBERCULOSIS, INFECTED PATIENTS, CELL COUNTS, AIDS
UCL classification: UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Infection and Immunity
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Medicine
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Medicine > Respiratory Medicine
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Pop Health Sciences > Institute for Global Health
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Pop Health Sciences > Institute for Global Health > Infection and Population Health
URI: http://discovery.ucl.ac.uk/id/eprint/167447
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