Incidence and predictors of death among adult patients treated for tuberculosis in two regions of Cameroon: 2010 to 2015

Objectives: Mortality during tuberculosis (TB) remains high in Africa. The purpose of our study was to determine the incidence and predictors of death during TB treatment in Cameroon. Materials and Methods: Data of subjects aged ≥15 years were retrospectively extracted from registers in all TB diagnostic and treatment centers in the Western and Northern regions of Cameroon from 2010 to 2015. Cox regression models were used to determine predictors of death during TB treatment. Results: Of the 19,681 patients included, 12,541 (63.7%) were male and their median age (25th-75th percentile) was 34 (26–45) years. The cumulative incidence (95% confidence interval [CI]) of death during TB treatment was 8.0% (7.5–8.5%). The predictors (hazard ratios [95% CI]) of death were: Age >34 years (1.479 [1.295–1.688], P < 0.001), female sex (1.471 [1.286–1.683], P < 0.001), extra-pulmonary TB (1.723 [1.466–2.026], P < 0.001), human immunodeficiency virus infection (3.739 [3.269–4.276], P < 001]), TB treatment in the Western region (2.241 [1.815–2.768], P < 0.001), treatment before 2012 (1.215 [1.073–1.376], P = 0.002)and low body weight (1st quartile and 2nd quartile) (2.568 [2.133–3.092], [P < 0.001]) and (1.569 [1.298–1.896], P < 0.001) respectively. Conclusion: The incidence of death during TB was relatively high in the Western and Northern regions of Cameroon. Recognition of these persons at greatest risk may improve care and reduce death durinng TB treatment.

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Persistent Replication of Human Immunodeficiency Virus Type 1 despite Treatment of Pulmonary Tuberculosis in Dually Infected Subjects

Clinical and Diagnostic Laboratory Immunology ◽

10.1128/cdli.12.11.1298-1304.2005 ◽

2005 ◽

Vol 12 (11) ◽

pp. 1298-1304 ◽

Cited By ~ 11

Author(s):

Harriet Mayanja Kizza ◽

Benigno Rodriguez ◽

Miguel Quinones-Mateu ◽

Muneer Mirza ◽

Htin Aung ◽

...

Keyword(s):

Human Immunodeficiency Virus ◽

Viral Load ◽

Treatment Needs ◽

Pulmonary Tb ◽

Tb Treatment ◽

Cell Counts ◽

Immunodeficiency Virus ◽

The Impact ◽

Hiv 1

ABSTRACT Tuberculosis (TB) is the most common life-threatening infection in human immunodeficiency virus (HIV)-infected persons and frequently occurs before the onset of severe immunodeficiency. Development of TB is associated with increased HIV type 1 (HIV-1) viral load, a fall in CD4 lymphocyte counts, and increased mortality. The aim of this study was to examine how treatment of pulmonary TB affected HIV-1 activity in HIV-1/TB-coinfected subjects with CD4 cell counts of >100 cells/μl. HIV-1/TB-coinfected subjects were recruited in Kampala, Uganda, and were monitored over time. Based upon a significant (0.5 log10 copies/ml) decrease in viral load by the end of treatment, two patient groups could be distinguished. Responders (n = 17) had more rapid resolution of anemia and pulmonary lesions on chest radiography during TB treatment. This group had a significant increase in viral load to levels not different from those at baseline 6 months after completion of TB treatment. HIV-1 viral load in nonresponders (n = 10) with TB treatment increased and at the 6 month follow-up was significantly higher than that at the time of diagnosis of TB. Compared to baseline levels, serum markers of macrophage activation including soluble CD14 decreased significantly by the end of TB treatment in responders but not in nonresponders. These data further define the impact of pulmonary TB on HIV-1 disease. HIV-1 replication during dual HIV-1/TB infection is not amenable to virologic control by treatment of TB alone. Concurrent institution of highly active antiretroviral treatment needs to be evaluated in patients dually infected with pulmonary TB and HIV-1.

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Risk Factors for Unfavorable Treatment Outcomes among the Human Immunodeficiency Virus-Associated Tuberculosis Population in Tashkent City, Uzbekistan: 2013–2017

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18094623 ◽

2021 ◽

Vol 18 (9) ◽

pp. 4623

Author(s):

Sherali Massavirov ◽

Kristina Akopyan ◽

Fazlkhan Abdugapparov ◽

Ana Ciobanu ◽

Arax Hovhanessyan ◽

...

Keyword(s):

Risk Factors ◽

Human Immunodeficiency Virus ◽

Treatment Outcomes ◽

Sputum Smear ◽

People Living With Hiv ◽

Tb Treatment ◽

Cell Counts ◽

Cd4 Cell Counts ◽

Immunodeficiency Virus ◽

Positive Sputum Smear

Tuberculosis (TB) and human immunodeficiency virus (HIV) co-infection poses a growing clinical challenge. People living with HIV have a higher chance of developing TB, and once the disease has progressed, are at greater risk of having unfavorable TB treatment outcomes. Data on TB treatment outcomes among the HIV-associated TB population in Uzbekistan are limited. Thus, we conducted a cohort study among 808 adult patients with HIV-associated TB registered at the Tashkent TB referral hospital from 2013–2017 to document baseline characteristics and evaluate risk factors for unfavorable TB treatment outcomes. The data were collected from medical records and ambulatory cards. About 79.8% of the study population had favorable treatment outcomes. Antiretroviral therapy (ART) coverage at the admission was 26.9%. Information on CD4-cell counts and viral loads were largely missing. Having extrapulmonary TB (aOR 2.21, 95% CI: 1.38–3.53, p = 0.001), positive sputum smear laboratory results on admission (aOR 1.62, 95% CI: 1.07–2.40), diabetes (aOR 5.16, 95% CI: 1.77–14.98), and hepatitis C (aOR 1.68, 95% CI: 1.14–2.46) were independent risk factors for developing unfavorable TB treatment outcomes. The study findings provide evidence for targeted clinical management in co-infected patients with risk factors. Strengthening the integration of TB/HIV services may improve availability of key data to improve co-infection management.

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Treatment Time or Convection Volume in HDF: What Drives the Reduced Mortality Risk?

Blood Purification ◽

10.1159/000430903 ◽

2015 ◽

Vol 40 (1) ◽

pp. 53-58 ◽

Cited By ~ 1

Author(s):

Camiel L.M. de Roij van Zuijdewijn ◽

Menso J. Nubé ◽

Piet M. ter Wee ◽

Peter J. Blankestijn ◽

Renée Lévesque ◽

...

Keyword(s):

Confidence Intervals ◽

Mortality Risk ◽

Survival Benefit ◽

Regression Models ◽

Cox Regression ◽

Treatment Time ◽

High Volume ◽

P Values ◽

Hazard Ratios

Background/Aims: Treatment time is associated with survival in hemodialysis (HD) patients and with convection volume in hemodiafiltration (HDF) patients. High-volume HDF is associated with improved survival. Therefore, we investigated whether this survival benefit is explained by treatment time. Methods: Participants were subdivided into four groups: HD and tertiles of convection volume in HDF. Three Cox regression models were fitted to calculate hazard ratios (HRs) for mortality of HDF subgroups versus HD: (1) crude, (2) adjusted for confounders, (3) model 2 plus mean treatment time. As the only difference between the latter models is treatment time, any change in HRs is due to this variable. Results: 114/700 analyzed individuals were treated with high-volume HDF. HRs of high-volume HDF are 0.61, 0.62 and 0.64 in the three models, respectively (p values <0.05). Confidence intervals of models 2 and 3 overlap. Conclusion: The survival benefit of high-volume HDF over HD is independent of treatment time.

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Impact of Assisted Peritoneal Dialysis Modality on Outcomes: A Cohort Study of the French Language Peritoneal Dialysis Registry

American Journal of Nephrology ◽

10.1159/000494664 ◽

2018 ◽

Vol 48 (6) ◽

pp. 425-433 ◽

Cited By ~ 7

Author(s):

Solène Guilloteau ◽

Thierry Lobbedez ◽

Sonia Guillouët ◽

Christian Verger ◽

Maxence Ficheux ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Lower Risk ◽

Regression Models ◽

Cox Regression ◽

French Language ◽

Dialysis Modality ◽

Technique Survival ◽

Hazard Ratios ◽

Effect Of Pd ◽

Assisted Peritoneal Dialysis

Background: Patients on peritoneal dialysis (PD) can be assisted by a nurse or a family member and treated either by automated PD (APD) or continuous ambulatory PD (CAPD). The aim of this study was to evaluate the effect of PD modality and type of assistance on the risk of transfer to haemodialysis (HD) and on the peritonitis risk in assisted PD patients. Method: This was a retrospective study based on data from the French Language PD Registry. All adults starting assisted PD in France between 2006 and 2015 were included. Events of interest were transfer to HD, peritonitis and death. Cox regression models were used for statistical analysis. Results: Among the 12,144 incident patients who started PD in France during the study period, 6,167 were assisted. There were 5,060 nurse-assisted and 1,095 family-assisted PD patients. Overall, 5,171 were treated by CAPD and 996 by APD. In multivariate analysis, CAPD, compared to APD, was not associated with the risk of transfer to HD (cause specific hazard ratios [cs-HR] 0.96 [95% CI 0.84–1.09]). Patients on nurse-assisted PD had a lower risk of transfer to HD than family assisted PD patients (cs-HR 0.85 [95% CI 0.75–0.97]). Neither PD modality nor type of assistance were associated with peritonitis risk. Conclusions: In assisted PD, technique survival was not associated with PD modality. Nurse-assisted patients had a lower risk of transfer to HD than family assisted patients. Peritonitis risk was not influenced either by PD modality, or by type of assistance. Both APD and CAPD should be offered to assisted-PD patients.

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Association of type of tuberculosis with treatment outcome among paediatric tuberculosis patients in Bhopal city

International Journal of Community Medicine and Public Health ◽

10.18203/2394-6040.ijcmph20174829 ◽

2017 ◽

Vol 4 (11) ◽

pp. 4205

Author(s):

Sheloj Joshi

Keyword(s):

Treatment Outcome ◽

Age Groups ◽

Study Data ◽

Age Group ◽

Tuberculosis Patients ◽

Pulmonary Tb ◽

Paediatric Patients ◽

Immunodeficiency Virus ◽

Extra Pulmonary ◽

Paediatric Tuberculosis

Background: Tuberculosis causes ill-health among millions of people each year and ranks as the second leading cause of death from an infectious disease worldwide, after the human immunodeficiency virus (HIV).The younger the child, the more are the chances of complications and death from the disease. The objective of the study was to find out the association of type of tuberculosis with the treatment outcome of paediatric TB patients registered under RNTCP in Bhopal city.Methods: A longitudinal study was conducted in all tuberculosis treatment units (TU) of Bhopal city. All paediatric patients in the age group of 0 to 14 years diagnosed as TB and registered under RNTCP and fulfilling inclusion criteria during January 2013 to June 2013 were included in the study. Data regarding paediatric TB patients was collected by using a structured questionnaire. Information was also obtained in two subsequent visits of the patient, one at the end of intensive phase to know the response of treatment and other at the end of the treatment for treatment outcome. The data was analysed on statistical software SPSS vs.20.Results: The present study was conducted on 165 paediatric Tuberculosis patients who were registered for DOTS treatment under RNTCP. Pulmonary TB is common in all the age group of <1 and 1-10 years. Out of 165 paediatric patients,93.33% of patients were treatment completed in which 54.54% were pulmonary cases and 45.45% were extra pulmonary while 4.84% were declared cured, thus showing statistically significant association (X2=9.758 and p=0.04, df=4) between type of Tuberculosis and treatment outcome.Conclusions: Pulmonary TB is common in the age groups of <1 and 1-10 years while in 11-14 years of age group extra pulmonary TB is more common. There is statistically significant association between type of Tuberculosis and treatment outcome.

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Anti- cyclic citrullinated peptide antibodies in tuberculosis and human immunodeficiency virus

International Journal of Advances in Medicine ◽

10.18203/2349-3933.ijam20201615 ◽

2020 ◽

Vol 7 (5) ◽

pp. 804

Author(s):

Rakesh K. Yadav ◽

Raj K. ◽

Kachnar V. ◽

Manoj K. Mathur ◽

Amitabh D. Shukla

Keyword(s):

Rheumatoid Arthritis ◽

Human Immunodeficiency Virus ◽

Virus Infection ◽

Pulmonary Tuberculosis ◽

Infectious Diseases ◽

Human Immunodeficiency Virus Infection ◽

Extra Pulmonary Tuberculosis ◽

Immunodeficiency Virus ◽

Extra Pulmonary ◽

Citrullinated Peptide

Background: Anti-cyclic citrullinated peptide (anti-CCP) antibodies have been considered very specific for rheumatoid arthritis (RA). Some studies have shown that these antibodies can be positive in infectious diseases like tuberculosis, human immunodeficiency virus infection, etc.Methods: Eighty patients of tuberculosis both pulmonary and extra-pulmonary tuberculosis and thirty patients of human immunodeficiency virus were enrolled in this study from inpatient and outpatient departments from September 2018 to August 2019. Anti-CCP antibody test was done in all the patient by enzyme linked immunosorbent assay.Results: Fifty-three patients were of pulmonary tuberculosis, 27 patients were extra-pulmonary tuberculosis and 30 patients were human immunodeficiency virus infection. Of the 53 cases of pulmonary tuberculosis, 21 (39.6%) cases were positive for anti-CCP antibodies and 32 (60.4%) cases were negative for the same. Of the 27 cases of extra-pulmonary tuberculosis, 3(11.1%) cases were positive for anti-CCP antibodies and 24 (88.9%) cases were negative. Of the 53 patients of pulmonary tuberculosis, 16 were sputum positive and 37 were sputum negative. Of those withsputum positive 9 (56.2%) cases were positive for anti-CCP antibodies and those with sputum negative, 12 (32.4%) cases were positive for anti-CCP antibodies. Of the 30 cases of human immunodeficiency virus, 5 (16.7%) cases were positive for anti-CCP antibodies and 25 (83.3%) cases were negative.Conclusions: Anti-CCP can be positive in cases of infectious diseases like tuberculosis and human immunodeficiency virus. Positivity of anti-CCP antibodies for tuberculosis is more for pulmonary (more for sputum-positive than sputum-negative) than extra-pulmonary tuberculosis. Anti-CCP, thus is not very specific for rheumatoid arthritis.

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Cerebrospinal Fluid Culture Positivity and Clinical Outcomes After Amphotericin-Based Induction Therapy for Cryptococcal Meningitis

Open Forum Infectious Diseases ◽

10.1093/ofid/ofv157 ◽

2015 ◽

Vol 2 (4) ◽

Cited By ~ 11

Author(s):

Melissa A. Rolfes ◽

Joshua Rhein ◽

Charlotte Schutz ◽

Kabanda Taseera ◽

Henry W. Nabeta ◽

...

Keyword(s):

Human Immunodeficiency Virus ◽

Cerebrospinal Fluid ◽

Clinical Outcomes ◽

Antifungal Therapy ◽

Induction Therapy ◽

Cryptococcal Meningitis ◽

Cox Regression ◽

Culture Positivity ◽

Immunodeficiency Virus ◽

Cerebrospinal Fluid Culture

Abstract Background. Amphotericin-based combination antifungal therapy reduces mortality from human immunodeficiency virus (HIV)-associated cryptococcal meningitis. However, 40%–50% of individuals have positive cerebrospinal fluid (CSF) fungal cultures at completion of 2 weeks of amphotericin induction therapy. Residual CSF culture positivity has historically been associated with poor clinical outcomes. We investigated whether persistent CSF fungemia was associated with detrimental clinical outcomes in a contemporary African cohort. Methods. Human immunodeficiency virus-infected individuals with cryptococcal meningitis in Uganda and South Africa received amphotericin (0.7–1.0 mg/kg per day) plus fluconazole (800 mg/day) for 2 weeks, followed by “enhanced consolidation” therapy with fluconazole 800 mg/day for at least 3 weeks or until cultures were sterile, and then 400 mg/day for 8 weeks. Participants were randomized to receive antiretroviral therapy (ART) either 1–2 or 5 weeks after diagnosis and observed for 6 months. Survivors were classified as having sterile or nonsterile CSF based on 2-week CSF cultures. Mortality, immune reconstitution inflammatory syndrome (IRIS), and culture-positive relapse were compared in those with sterile or nonsterile CSF using Cox regression. Results. Of 132 participants surviving 2 weeks, 57% had sterile CSF at 2 weeks, 23 died within 5 weeks, and 40 died within 6 months. Culture positivity was not significantly associated with mortality (adjusted 6-month hazard ratio, 1.2; 95% confidence interval, 0.6–2.3; P = .28). Incidence of IRIS or relapse was also not significantly related to culture positivity. Conclusions. Among patients, all treated with enhanced consolidation antifungal therapy and ART, residual cryptococcal culture positivity was not found to be associated with poor clinical outcomes.

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Toll-Like Receptor 2 Promoter -196 to -174 Deletion Affects CD4 Levels Along Human Immunodeficiency Virus Infection Progression

The Journal of Infectious Diseases ◽

10.1093/infdis/jiaa327 ◽

2020 ◽

Vol 222 (12) ◽

pp. 2007-2011 ◽

Cited By ~ 1

Author(s):

Marina Laplana ◽

Maria Jose Bravo ◽

Marta Fernández-Fuertes ◽

Celia Ruiz-Garcia ◽

Emilio Alarcón-Martin ◽

...

Keyword(s):

Human Immunodeficiency Virus ◽

Disease Progression ◽

Cox Regression ◽

Toll Like Receptor ◽

Cox Regression Analysis ◽

Immunodeficiency Virus ◽

Toll Like Receptor 2 ◽

Time Required ◽

Molecular Patterns ◽

Hiv 1

Abstract Toll-like receptor 2 (TLR2) plays a key role in innate immune response recognizing molecular patterns expressed by pathogens. rs111200466 is a TLR2 promoter insertion/deletion polymorphism with contradictory data about its role in human immunodeficiency virus type 1 (HIV-1) infection. We analyzed rs111200466 in HIV-1 disease progression and showed a correlation with a faster progression to the CD4+ < 200 cells/μL outcome for deletion allele carriers (Cox regression analysis: hazard ratio, 2.4 [95% confidence interval, 1.4–4]; P = .001). When naive patients with CD4+ < 200 cells/μL started antiretroviral treatment, rs111200466-deletion carriers showed a trend toward a slower, recovery rate (time required to reach CD4+ > 350 cells/μL; Cox P = .36). Our data suggest rs111200466 as a prognosis factor for HIV-1 disease progression.

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Outcomes of Coronavirus Disease 2019 (COVID-19) Related Hospitalization Among People With Human Immunodeficiency Virus (HIV) in the ISARIC World Health Organization (WHO) Clinical Characterization Protocol (UK): A Prospective Observational Study

Clinical Infectious Diseases ◽

10.1093/cid/ciaa1605 ◽

2020 ◽

Cited By ~ 3

Author(s):

Anna Maria Geretti ◽

Alexander J Stockdale ◽

Sophie H Kelly ◽

Muge Cevik ◽

Simon Collins ◽

...

Keyword(s):

Human Immunodeficiency Virus ◽

World Health Organization ◽

Cox Regression ◽

World Health ◽

Rank Test ◽

Hiv Positive ◽

Protein Levels ◽

Increased Risk ◽

Immunodeficiency Virus ◽

Health Organization

Abstract Background Evidence is conflicting about how human immunodeficiency virus (HIV) modulates coronavirus disease 2019 (COVID-19). We compared the presentation characteristics and outcomes of adults with and without HIV who were hospitalized with COVID-19 at 207 centers across the United Kingdom and whose data were prospectively captured by the International Severe Acute Respiratory and Emerging Infection Consortium (ISARIC) World Health Organization (WHO) Clinical Characterization Protocol (CCP) study. Methods We used Kaplan-Meier methods and Cox regression to describe the association between HIV status and day-28 mortality, after separate adjustment for sex, ethnicity, age, hospital acquisition of COVID-19 (definite hospital acquisition excluded), presentation date, 10 individual comorbidities, and disease severity at presentation (as defined by hypoxia or oxygen therapy). Results Among 47 592 patients, 122 (0.26%) had confirmed HIV infection, and 112/122 (91.8%) had a record of antiretroviral therapy. At presentation, HIV-positive people were younger (median 56 vs 74 years; P < .001) and had fewer comorbidities, more systemic symptoms and higher lymphocyte counts and C-reactive protein levels. The cumulative day-28 mortality was similar in the HIV-positive versus HIV-negative groups (26.7% vs. 32.1%; P = .16), but in those under 60 years of age HIV-positive status was associated with increased mortality (21.3% vs. 9.6%; P < .001 [log-rank test]). Mortality was higher among people with HIV after adjusting for age (adjusted hazard ratio [aHR] 1.47, 95% confidence interval [CI] 1.01–2.14; P = .05), and the association persisted after adjusting for the other variables (aHR 1.69; 95% CI 1.15–2.48; P = .008) and when restricting the analysis to people aged <60 years (aHR 2.87; 95% CI 1.70–4.84; P < .001). Conclusions HIV-positive status was associated with an increased risk of day-28 mortality among patients hospitalized for COVID-19.

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Lung Injury on Antiretroviral Therapy in Adults With Human Immunodeficiency Virus/Tuberculosis

Clinical Infectious Diseases ◽

10.1093/cid/ciz560 ◽

2019 ◽

Vol 70 (9) ◽

pp. 1845-1854 ◽

Cited By ~ 3

Author(s):

Shruthi Ravimohan ◽

Sara C Auld ◽

Pholo Maenetje ◽

Nelly Ratsela ◽

Mandla Mlotshwa ◽

...

Keyword(s):

Human Immunodeficiency Virus ◽

T Cell ◽

Lung Function ◽

Lung Inflammation ◽

Pulmonary Inflammation ◽

Cd4 T Cell ◽

Pulmonary Tb ◽

Art Initiation ◽

Pet Ct ◽

Immunodeficiency Virus

Abstract Background Immune restoration on antiretroviral therapy (ART) can drive inflammation in people living with human immunodeficiency virus (HIV) who have pulmonary tuberculosis (TB), but its effects on the lungs have not been assessed. We evaluated associations between pulmonary inflammation, recovery of pathogen-specific CD4 T-cell function, and lung injury prior to and after ART initiation in adults with HIV and pulmonary TB. Methods This was a prospective cohort study in South Africa, following adults with HIV and pulmonary TB prior to and up to 48 weeks after ART initiation. Pulmonary-specific inflammation was defined as total glycolytic activity (TGA) on [18]F-fluorodeoxyglucose (FDG) positron emission tomography–computed tomography (PET-CT) at baseline and 4 weeks after ART initiation. Spirometry, respiratory symptom tests, and flow cytometry were performed at the same times to assess lung involvement and the frequency of mycobacteria-specific CD4 T-cells. In addition, we evaluated lung function longitudinally up to 48 weeks after ART initiation. Results Greater lung TGA on FDG PET-CT was associated with worse lung function and respiratory symptoms prior to ART initiation, and nearly half of subjects experienced worsening lung inflammation and lung function at Week 4 of ART. Worsening Week 4 lung inflammation and pulmonary function were both associated with greater increases in pathogen-specific functional CD4 T-cell responses on ART, and early decreases in lung function were independently associated with persistently lower lung function months after TB treatment completion. Conclusions Increases in pulmonary inflammation and decreases in lung function are common on ART, relate to greater ART-mediated CD4 T-cell restoration, and are associated with the persistent impairment of lung function in individuals with HIV/TB.

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