scholarly journals Incidence of tuberculosis among HIV-positive adults on antiretroviral therapy at Debre Markos Referral Hospital, Northwest Ethiopia: A retrospective record review

2019 ◽  
Author(s):  
Belisty Temesgen ◽  
Getiye Dejenu Kibret ◽  
Nakachew Mekonnen Alamirew ◽  
Animut Alebel
Keyword(s):  
Human Immunodeficiency Virus ◽  
Opportunistic Infections ◽  
Hemoglobin Level ◽  
Disease Stage ◽  
Hiv Positive ◽  
Retrospective Record Review ◽  
Immunodeficiency Virus ◽  
Hiv Positive Adults ◽  
Record Review

Abstract Background: Tuberculosis is the leading cause of morbidity and mortality among people living with human immunodeficiency virus. Almost one-third of deaths among people living with human immunodeficiency virus are attributed to tuberculosis. Despite this fact, in Ethiopia, particularly in our study area there is a scarcity of information regarding the incidence and predictors of TB among peoples living with HIV. Thus, this study aimed to assess the incidence and predictors of tuberculosis among HIV-positive adults on ART. Methods: A retrospective record review was conducted among 544 HIV-positive adults on ART at Debre Markos Referral Hospital from January 1, 2012 to December 31, 2017. The study participants were selected using a simple random sampling technique. The data extraction format was adapted from ART intake and follow-up forms. Data were entered using Epi-Data version 4.2 and analyzed using STATA Version 13. Tuberculosis free survival time was estimated using the Kaplan-Meier survival curve. Both the bi-variable and multivariable Cox-proportional hazard regression models were used to identify predictors of the time to develop TB. Results: Among 492 HIV-positive adults included in the final analysis, 16.9% developed TB at the time of follow up. The incidence rate of TB was found to be 6.5 (95%CI: 5.2, 8.0) per 100-person years of observation. Advanced WHO clinical disease stage (III and IV) (AHR: 2.1, 95% CI: 1.2, 3.2), being ambulatory and bedridden (AHR: 1.8, 95% CI: 1.1, 3.1), baseline opportunistic infections (AHR: 2.8, 95% CI: 1.7, 4.4), low hemoglobin level (AHR: 3.5, 95% CI: 2.1, 5.8), and not taking IPT (AHR: 3.9, 95% CI: 1.9, 7.6) were found to be the predictors of TB. Conclusion: In this study, a high incidence rate of TB was observed among HIV-positive adults. Advanced WHO clinical disease stage (III and IV), being ambulatory and bedridden, baseline opportunistic infections, low hemoglobin level, and not taking IPT were found to be the predictors of TB. Keywords: HIV, Incidence, Predictors, TB

scholarly journals Incidence and predictors of tuberculosis among HIV-positive adults on antiretroviral therapy at Debre Markos Referral Hospital, Northwest Ethiopia: A retrospective record review

2019 ◽  
Author(s):  
Belisty Temesgen ◽  
Getiye Dejenu Kibret ◽  
Nakachew Mekonnen Alamirew ◽  
Animut Alebel
Keyword(s):  
Opportunistic Infections ◽  
Hemoglobin Level ◽  
Disease Stage ◽  
Hiv Positive ◽  
Retrospective Record Review ◽  
Immunodeficiency Virus ◽  
Hiv Positive Adults ◽  
Debre Markos ◽  
Record Review

Abstract Background: Tuberculosis (TB) is the leading cause of morbidity and mortality among people living with human immunodeficiency virus. Almost one-third of deaths among people living with human immunodeficiency virus (PLHIV) are attributed to tuberculosis. Despite this fact, in Ethiopia, particularly in our study area there is a scarcity of information regarding the incidence and predictors of TB among people living with HIV. Thus, this study aimed to assess the incidence and predictors of tuberculosis among HIV-positive adults on antiretroviral therapy (ART). Methods: A retrospective record review was conducted among 544 HIV-positive adults on ART at Debre Markos Referral Hospital from January 1, 2012 to December 31, 2017. The study participants were selected using a simple random sampling technique. The data extraction format was adapted from ART intake and follow-up forms. Cox-proportional hazards regression model was fitted and Cox-Snell residual test was used to assess the goodness of fit. Model with the least value of Akaike’s information criteria was selected as the best model. Tuberculosis free survival time was estimated using the Kaplan-Meier survival curve. Both the bi-variable and multivariable Cox-proportional hazard regression models were used to identify predictors of TB. Results: Among 492 HIV-positive adults included in the final analysis, 16.9% developed TB at the time of follow-up. The incidence rate of TB was found to be 6.5 (95%CI: 5.2, 8.0) per 100-person-years of observation. Advanced WHO clinical disease stage (III and IV) (AHR: 2.1, 95% CI: 1.2, 3.2), being ambulatory and bedridden (AHR: 1.8, 95% CI: 1.1, 3.1), baseline opportunistic infections (AHR: 2.8, 95% CI: 1.7, 4.4), low hemoglobin level (AHR: 3.5, 95% CI: 2.1, 5.8), and not taking IPT (AHR: 3.9, 95% CI: 1.9, 7.6) were found to be the predictors of TB. Conclusion: The study found that there was a high rate of TB occurrence as compared to previous studies. Baseline opportunistic infections, being ambulatory and bedridden, advanced disease stage, low hemoglobin level, and not taking IPT were found to be the predictors of TB. Therefore, early detection and treatment of opportunistic infections like TB should get a special attention. Keywords: Debre Markos, HIV, Incidence, Predictors, TB

scholarly journals Incidence and predictors of tuberculosis among HIV-positive adults on antiretroviral therapy at Debre Markos Referral Hospital, Northwest Ethiopia: A retrospective record review

2019 ◽  
Author(s):  
Belisty Temesgen ◽  
Getiye Dejenu Kibret ◽  
Nakachew Mekonnen Alamirew ◽  
Animut Alebel
Keyword(s):  
Opportunistic Infections ◽  
Hemoglobin Level ◽  
Disease Stage ◽  
Hiv Positive ◽  
Retrospective Record Review ◽  
Immunodeficiency Virus ◽  
Hiv Positive Adults ◽  
Debre Markos ◽  
Record Review

Abstract Background: Tuberculosis (TB) is the leading cause of morbidity and mortality among people living with human immunodeficiency virus. Almost one-third of deaths among people living with human immunodeficiency virus (PLHIV) are attributed to tuberculosis. Despite this fact, in Ethiopia, particularly in our study area there is a scarcity of information regarding the incidence and predictors of TB among people living with HIV. Thus, this study aimed to assess the incidence and predictors of tuberculosis among HIV-positive adults on antiretroviral therapy (ART). Methods: A retrospective record review was conducted among 544 HIV-positive adults on ART at Debre Markos Referral Hospital from January 1, 2012 to December 31, 2017. The study participants were selected using a simple random sampling technique. The data extraction format was adapted from ART intake and follow-up forms. Cox-proportional hazards regression model was fitted and Cox-Snell residual test was used to assess the goodness of fit. Model with the least value of Akaike’s information criteria was selected as the best model. Tuberculosis free survival time was estimated using the Kaplan-Meier survival curve. Both the bi-variable and multivariable Cox-proportional hazard regression models were used to identify predictors of TB. Results: Among 492 HIV-positive adults included in the final analysis, 16.9% developed TB at the time of follow-up. The incidence rate of TB was found to be 6.5 (95%CI: 5.2, 8.0) per 100-person-years of observation. Advanced WHO clinical disease stage (III and IV) (AHR: 2.1, 95% CI: 1.2, 3.2), being ambulatory and bedridden (AHR: 1.8, 95% CI: 1.1, 3.1), baseline opportunistic infections (AHR: 2.8, 95% CI: 1.7, 4.4), low hemoglobin level (AHR: 3.5, 95% CI: 2.1, 5.8), and not taking IPT (AHR: 3.9, 95% CI: 1.9, 7.6) were found to be the predictors of TB. Conclusion: The study found that there was a high rate of TB occurrence as compared to previous studies. Baseline opportunistic infections, being ambulatory and bedridden, advanced disease stage, low hemoglobin level, and not taking IPT were found to be the predictors of TB. Therefore, early detection and treatment of opportunistic infections like TB should get a special attention. Keywords: Debre Markos, HIV, Incidence, Predictors, TB

scholarly journals Incidence and predictors of tuberculosis among HIV-positive adults on antiretroviral therapy at Debre Markos referral hospital, Northwest Ethiopia: a retrospective record review

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Belisty Temesgen ◽  
Getiye Dejenu Kibret ◽  
Nakachew Mekonnen Alamirew ◽  
Mamaru Wubale Melkamu ◽  
Yitbarek Tenaw Hibstie ◽  
...  
Keyword(s):  
Antiretroviral Therapy ◽  
Opportunistic Infections ◽  
Preventive Therapy ◽  
Hemoglobin Level ◽  
Disease Stage ◽  
Hiv Positive ◽  
Immunodeficiency Virus ◽  
Hiv Positive Adults ◽  
Record Review

Abstract Background Tuberculosis is the leading cause of morbidity and mortality among people living with human immunodeficiency virus. Almost one-third of deaths among people living with human immunodeficiency virus are attributed to tuberculosis. Despite this evidence, in Ethiopia, there is a scarcity of information regarding the incidence and predictors of tuberculosis among people living with HIV. Thus, this study assessed the incidence and predictors of tuberculosis among HIV-positive adults on antiretroviral therapy. Methods This study was a retrospective record review including 544 HIV-positive adults on antiretroviral therapy at Debre Markos Referral Hospital between January 1, 2012 and December 31, 2017. The study participants were selected using a simple random sampling technique. The data extraction format was adapted from antiretroviral intake and follow-up forms. Cox-proportional hazards regression model was fitted and Cox-Snell residual test was used to assess the goodness of fit. Tuberculosis free survival time was estimated using the Kaplan-Meier survival curve. Both the bi-variable and multivariable Cox-proportional hazard regression models were used to identify predictors of tuberculosis. Results In the final analysis, a total of 492 HIV-positive adults were included, of whom, 83 (16.9%) developed tuberculosis at the time of follow-up. This study found that the incidence of tuberculosis was 6.5 (95% CI: 5.2, 8.0) per 100-person-years (PY) of observation. Advanced World Health Organization clinical disease stage (III and IV) (AHR: 2.1, 95% CI: 1.2, 3.2), being ambulatory and bedridden (AHR: 1.8, 95% CI: 1.1, 3.1), baseline opportunistic infections (AHR: 2.8, 95% CI: 1.7, 4.4), low hemoglobin level (AHR: 3.5, 95% CI: 2.1, 5.8), and not taking Isonized Preventive Therapy (AHR: 3.9, 95% CI: 1.9, 7.6) were found to be the predictors of tuberculosis. Conclusion The study found that there was a high rate of tuberculosis occurrence as compared to previous studies. Baseline opportunistic infections, being ambulatory and bedridden, advanced disease stage, low hemoglobin level, and not taking Isonized Preventive Therapy were found to be the predictors of tuberculosis. Therefore, early detection and treatment of opportunistic infections like tuberculosis should get a special attention.

scholarly journals Incidence of tuberculosis among HIV-positive adults on antiretroviral therapy at Debre Markos Referral Hospital, Northwest Ethiopia: A retrospective cohort study

2019 ◽  
Author(s):  
Belisty Temesgen ◽  
Getiye Dejenu Kibret ◽  
Nakachew Mekonnen Alamirew ◽  
Animut Alebel
Keyword(s):  
Human Immunodeficiency Virus ◽  
Cohort Study ◽  
Retrospective Cohort ◽  
Opportunistic Infections ◽  
Hemoglobin Level ◽  
Disease Stage ◽  
Hiv Positive ◽  
Immunodeficiency Virus ◽  
Hiv Positive Adults

Abstract Background: Tuberculosis is the leading cause of morbidity and mortality among people living with human immunodeficiency virus. Almost one-third of deaths among people living with human immunodeficiency virus are attributed to tuberculosis. Despite this fact, in Ethiopia, particularly in our study area there is a scarcity of information regarding the incidence and predictors of TB among peoples living with HIV. Thus, this study aimed to assess the incidence and predictors of tuberculosis among HIV positive adults. Methods: An institution based retrospective cohort study was conducted among 544 HIV-positive adults on ART at Debre Markos Referral Hospital from January 1, 2012 to December 31, 2017. The study participants were selected using a simple random sampling technique. The data extraction format was adapted from ART intake and follow-up forms. Data were entered using Epi-Data version 4.2 and analyzed using STATA Version 13. Tuberculosis free survival time was estimated using the Kaplan-Meier survival curve. Both the bi-variable and multivariable Cox-proportional hazard regression models were used to identify predictors of the time to develop TB. Results: Among 492 HIV-positive adults included in the final analysis, 16.9% of them developed TB at the time of follow up. The incidence rate of TB was found to be 6.5 (95%CI: 5.2, 8.0) per 100-person years. Advanced WHO clinical disease stage (III and IV) (AHR: 2.1, 95% CI: 1.2, 3.2), being ambulatory and bedridden (AHR: 1.8, 95% CI: 1.1, 3.1), baseline opportunistic infections (AHR: 2.8, 95% CI: 1.7, 4.4), low hemoglobin level (AHR: 3.5, 95% CI: 2.1, 5.8), and not taking IPT (AHR: 3.9, 95% CI: 1.9, 7.6) were found to be predictors of the time to develop TB. Conclusion: In this study, a high incidence rate of TB was observed among HIV-positive adults. Advanced HIV disease stage (III and IV), being ambulatory and bedridden, having opportunistic infections, having a low hemoglobin level, and not taking IPT were found to be predictors of the time to develop TB. Keywords: HIV, Incidence, Predictors, TB

scholarly journals Incidence and predictors of tuberculosis among HIV-positive adults on antiretroviral therapy at Debre Markos Referral Hospital, Northwest Ethiopia: A retrospective record review

2019 ◽  
Author(s):  
Belisty Temesgen ◽  
Getiye Dejenu Kibret ◽  
Nakachew Mekonnen Alamirew ◽  
Mamaru Wubale Melkamu ◽  
Yitbarek Tenaw Hibstie ◽  
...  
Keyword(s):  
Antiretroviral Therapy ◽  
Opportunistic Infections ◽  
Preventive Therapy ◽  
Disease Stage ◽  
Hiv Positive ◽  
Immunodeficiency Virus ◽  
Hiv Positive Adults ◽  
Debre Markos ◽  
Record Review

Abstract Background: Tuberculosis is the leading cause of morbidity and mortality among people living with human immunodeficiency virus. Almost one-third of deaths among people living with human immunodeficiency virus are attributed to tuberculosis. Despite this evidence, in Ethiopia, there is a scarcity of information regarding the incidence and predictors of tuberculosis among people living with HIV. Thus, this study assessed the incidence and predictors of tuberculosis among HIV-positive adults on antiretroviral therapy. Methods: This study was a retrospective record review including 544 HIV-positive adults on antiretroviral therapy at Debre Markos Referral Hospital between January 1, 2012 and December 31, 2017. The study participants were selected using a simple random sampling technique. The data extraction format was adapted from antiretroviral intake and follow-up forms. Cox-proportional hazards regression model was fitted and Cox-Snell residual test was used to assess the goodness of fit. Tuberculosis free survival time was estimated using the Kaplan-Meier survival curve. Both the bi-variable and multivariable Cox-proportional hazard regression models were used to identify predictors of tuberculosis. Results: In the final analysis, a total of 492 HIV-positive adults were included, of whom, 83 (16.9%) developed tuberculosis at the time of follow-up. This study found that the incidence of tuberculosis was 6.5 (95% CI: 5.2, 8.0) per 100-person-years (PY) of observation. Advanced World Health Organization clinical disease stage (III and IV) (AHR: 2.1, 95% CI: 1.2, 3.2), being ambulatory and bedridden (AHR: 1.8, 95% CI: 1.1, 3.1), baseline opportunistic infections (AHR: 2.8, 95% CI: 1.7, 4.4), low hemoglobin level (AHR: 3.5, 95% CI: 2.1, 5.8), and not taking Isonized Preventive Therapy (AHR: 3.9, 95% CI: 1.9, 7.6) were found to be the predictors of tuberculosis. Conclusion: The study found that there was a high rate of tuberculosis occurrence as compared to previous studies. Baseline opportunistic infections, being ambulatory and bedridden, advanced disease stage, low hemoglobin level, and not taking Isonized Preventive Therapy were found to be the predictors of tuberculosis. Therefore, early detection and treatment of opportunistic infections like tuberculosis should get a special attention. Keywords: Debre Markos, HIV, Incidence, Predictors, tuberculosis

scholarly journals Standardized Urine-Based Tuberculosis (TB) Screening With TB-Lipoarabinomannan and Xpert MTB/RIF Ultra in Ugandan Adults With Advanced Human Immunodeficiency Virus Disease and Suspected Meningitis

2020 ◽  
Vol 7 (4) ◽  
Author(s):  
Fiona V Cresswell ◽  
Jayne Ellis ◽  
Enock Kagimu ◽  
Ananta S Bangdiwala ◽  
Michael Okirwoth ◽  
...  
Keyword(s):  
Human Immunodeficiency Virus ◽  
Odds Ratio ◽  
Virus Disease ◽  
Extrapulmonary Tuberculosis ◽  
Hiv Positive ◽  
Systematic Screening ◽  
Immunodeficiency Virus ◽  
Cell Pellet ◽  
Hiv Positive Adults ◽  
Advanced Hiv Disease

Abstract Background Diagnosis of extrapulmonary tuberculosis (TB) remains challenging. We sought to determine the prevalence of disseminated TB by testing urine with TB-lipoarabinomannan (TB-LAM) lateral flow assay and Xpert MTB/RIF Ultra (Ultra) in hospitalized adults. Methods We prospectively enrolled human immunodeficiency virus (HIV)-positive adults with suspected meningitis in Uganda during 2018–2020. Participants underwent standardized urine-based TB screening. Urine (60 mcL) was tested with TB-LAM (Alere), and remaining urine was centrifuged with the cell pellet resuspended in 2 mL of urine for Xpert Ultra testing. Results We enrolled 348 HIV-positive inpatients with median CD4 of 37 cells/mcL (interquartile range, 13–102 cells/mcL). Overall, 26% (90 of 348; 95% confidence interval [CI], 21%–30%) had evidence of disseminated TB by either urine assay. Of 243 participants with both urine TB-LAM and Ultra results, 20% (48 of 243) were TB-LAM-positive, 12% (29 of 243) were Ultra-positive, and 6% (14 of 243) were positive by both assays. In definite and probable TB meningitis, 37% (14 of 38) were TB-LAM-positive and 41% (15 of 37) were Ultra-positive. In cryptococcal meningitis, 22% (40 of 183) were TB-LAM-positive and 4.4% (6 of 135) were Ultra-positive. Mortality trended higher in those with evidence of disseminated TB by either assay (odds ratio = 1.44; 95% CI, 0.83–2.49; P = .19) and was 6-fold higher in those with definite TB meningitis who were urine Ultra-positive (odds ratio = 5.67; 95% CI, 1.13–28.5; P = .04). Conclusions In hospitalized Ugandans with advanced HIV disease and suspected meningitis, systematic screening with urine TB-LAM and Ultra found a high prevalence of urine TB test positivity (26%). In those with TB meningitis, urine tests were positive in over one third. There was little concordance between Ultra and TB-LAM, which warrants further investigation.

Gestational trophoblastic syndrome and human immunodeficiency virus (HIV) infection: A retrospective analysis

2003 ◽  
Vol 13 (6) ◽  
pp. 875-878 ◽  
Author(s):  
M. Moodley ◽  
J. Moodley
Keyword(s):  
Human Immunodeficiency Virus ◽  
Hiv Infection ◽  
Case Reports ◽  
Hiv Positive ◽  
Risk Category ◽  
Immunodeficiency Virus ◽  
The Subject ◽  
The Mean ◽  
Sub Saharan

The appropriate management of gynecological malignancies in association with human immunodeficiency virus (HIV) infection is not established. To date the reported literature on the subject consists mainly of case reports. Due to the increasing prevalence of HIV infection, especially in sub-Saharan countries, the chances of finding both conditions in the same patient has produced management and ethical dilemmas. This retrospective study describes the management of 12 HIV-infected patients and compares their outcome with 29 non HIV-infected patients. The mean age of the non HIV-infected patients was 30 years (range 16–56 years), while the mean age of the HIV-infected patients was 32 years (range 20–47 years). In terms of risk factors, there were 72% of non HIV-infected women in the high-risk category compared to 50% of HIV-infected women (P = 0.468). All patients who received treatment had CD4 counts greater than 200 cells/μl. Two HIV-infected women who did not receive any form of chemotherapy due to low CD4 counts (41 cells/μl and 84 cells/μl) demised of their disease. The majority of women (86% non HIV-infected & 90% HIV-infected) received lfewer than 10 cycles of chemotherapy to attain cure. Most side effects were minor. None of the HIV-infected patients who received chemotherapy demised of their disease. In total, irrespective of risk category, there were 38 patients (93%) who were cured of their disease by chemotherapy including 10 HIV-positive patients. All patients were alive and free of disease at their last follow-up visit. Although the numbers are small, it is proposed that HIV-infected patients with choriocarcinoma and a reasonable degree of CD4 counts (>200cells/μl) should receive standard therapy.

Acroangiodermatitis mimicking Kaposi’s sarcoma in an HIV-positive man

2018 ◽  
Vol 29 (7) ◽  
pp. 729-731 ◽  
Author(s):  
BP Goorney ◽  
J Newsham ◽  
D Fitzgerald ◽  
L Motta
Keyword(s):  
Human Immunodeficiency Virus ◽  
Causative Agent ◽  
Kaposi's Sarcoma ◽  
Opportunistic Infections ◽  
Human Herpesvirus ◽  
Kaposi’S Sarcoma ◽  
Human Herpesvirus 8 ◽  
Hiv Positive ◽  
Herpesvirus 8 ◽  
Immunodeficiency Virus

Kaposi’s sarcoma (KS) is the commonest human immunodeficiency virus (HIV)-related malignancy with its characteristic cutaneous morphological appearance and histopathological features. However, it can be simulated by other co-morbid opportunistic infections and unrelated dermatological conditions. We describe such a case of acroangiodermatitis in an HIV co-infected man, based on exclusion of KS histologically and the absence of human herpesvirus 8, the causative agent of KS.

Infectious pseudomonas subglottic stenosis occurring in a patient with acquired immunodeficiency syndrome

1997 ◽  
Vol 111 (1) ◽  
pp. 70-72 ◽  
Author(s):  
K. Ghufoor ◽  
J. Almeyda ◽  
G. Mochloulis ◽  
P. Q. Montgomery ◽  
N. S. Tolley
Keyword(s):  
Human Immunodeficiency Virus ◽  
Pseudomonas Aeruginosa ◽  
Acquired Immunodeficiency Syndrome ◽  
Opportunistic Infections ◽  
Hiv Positive ◽  
Immunodeficiency Virus ◽  
Prevention And Treatment ◽  
Acquired Immunodeficiency ◽  
Immunodeficiency Syndrome ◽  
Infective Agent

AbstractPseudomonas aeruginosa is emerging as an increasingly common opportunistic infective agent in the immunocompromised human immunodeficiency virus (HIV) positive patient (Kielhofner et al., 1992). Improvements in the prevention and treatment of opportunistic infections in HIV and acquired immunodeficiency syndrome (AIDS) has led to longer life expectancy (Graham et al., 1992), and this has changed the incidence of Pseudomonas aeruginosa infection in this population (Baron and Hollander, 1993). We present a case of a patient with AIDS who developed a fulminant Pseudomonas aeruginosa stenosing subglottic infection. We are unaware of any previous reports of this particular manifestation of Pseudomonas aeruginosa infection.

scholarly journals Urine Lipoarabinomannan Testing in Adults With Advanced Human Immunodeficiency Virus in a Trial of Empiric Tuberculosis Therapy

2021 ◽  
Author(s):  
Mitch M Matoga ◽  
Gregory P Bisson ◽  
Amita Gupta ◽  
Sachiko Miyahara ◽  
Xin Sun ◽  
...  
Keyword(s):  
Human Immunodeficiency Virus ◽  
Clinical Symptoms ◽  
Preventive Therapy ◽  
Hiv Positive ◽  
Kaplan Meier ◽  
Immunodeficiency Virus ◽  
Hiv Positive Adults ◽  
Intent To Treat ◽  
Aids Clinical Trials ◽  
Tuberculosis Therapy

Abstract Background The urine lipoarabinomannan (LAM) antigen test is a tuberculosis (TB) diagnostic test with highest sensitivity in individuals with advanced human immunodeficiency virus (HIV). Its role in TB diagnostic algorithms for HIV-positive outpatients remains unclear. Methods The AIDS Clinical Trials Group (ACTG) A5274 trial demonstrated that empiric TB therapy did not improve 24-week survival compared to isoniazid preventive therapy (IPT) in TB screen–negative HIV-positive adults initiating antiretroviral therapy with CD4 counts <50 cells/µL. Retrospective LAM testing was performed on stored urine obtained at baseline. We determined the proportion of LAM-positive participants and conducted modified intent-to-treat analysis excluding LAM-positive participants to determine the effect on 24-week survival, TB incidence, and time to TB using Kaplan-Meier method. Results A5274 enrolled 850 participants; 53% were male and the median CD4 count was 18 (interquartile range, 9–32) cells/µL. Of the 850, 566 (67%) had LAM testing (283 per arm); 28 (5%) were positive (21 [7%] and 7 [2%] in the empiric and IPT arms, respectively). Of those LAM-positive, 1 participant in each arm died and 5 of 21 and 0 of 7 in empiric and IPT arms, respectively, developed TB. After excluding these 28 cases, there were 19 and 21 deaths in the empiric and IPT arms, respectively (P = .88). TB incidence remained higher (4.6% vs 2%, P = .04) and time to TB remained faster in the empiric arm (P = .04). Conclusions Among outpatients with advanced HIV who screened negative for TB by clinical symptoms, microscopy, and Xpert testing, LAM testing identified an additional 5% of individuals with TB. Positive LAM results did not change mortality or TB incidence.

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