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Initiation of antiretroviral therapy in HIV-infected tuberculosis patients in rural Kenya: an observational study

Stockdale, AJ, Nkuranga, J, Torok, ME, Faragher, Brian and Lalloo, David ORCID: https://orcid.org/0000-0001-7680-2200 (2013) 'Initiation of antiretroviral therapy in HIV-infected tuberculosis patients in rural Kenya: an observational study'. Tropical Medicine & International Health, Vol 18, Issue 7, pp. 907-914.

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Abstract

Objective
To provide information on the effect of timing of antiretroviral therapy (ART) initiation on outcomes of TB infection in real-life, non-clinical trial, rural settings in sub-Saharan Africa.
Methods
We conducted an observational cohort study of all HIV-infected TB patients presenting to a rural hospital in Kenya between 2005 and 2009. We analysed the association between timing of initiation of ART and mortality, using a Cox regression survival analysis, adjusted for measured confounders.
Results
A total of 404 antiretroviral-naïve HIV/TB coinfected patients were included in the study. Initiation of ART during the first 8 weeks of TB treatment (early group) was not associated with changes in mortality at 1 year compared with initiation of ART after 8 weeks (late group) [Hazard Ratio (HR) = 0.74 (Confidence Interval (CI), 0.33–1.64, P = 0.46]. In patients with baseline CD4 counts ≤50 cells/μl, there was a significant reduction in mortality in the early group compared with the late group (HR = 0.20; 95% CI, 0.042–0.99; P = 0.049). In patients with a CD4 count >50 cells/μl, there was no significant difference between early and late groups (HR 1.79; 95% CI, 0.64–5.03; P = 0.27).
Conclusions
We found that in HIV/TB coinfected patients in rural Kenya, early ART initiation (within 8 weeks) was associated with reduced mortality in those with CD4 counts ≤50 cells/μl. In patients with CD4 counts >50 cells/μl, there was no association seen between timing of ART and mortality.

Item Type: Article
Subjects: WA Public Health > Health Problems of Special Population Groups > WA 395 Health in developing countries
WC Communicable Diseases > Virus Diseases > Acquired Immunodeficiency Syndrome. HIV Infections > WC 503 Acquired immunodeficiency syndrome. HIV infections
WF Respiratory System > Tuberculosis > WF 200 Tuberculosis (General)
WF Respiratory System > Tuberculosis > WF 360 Drug therapy
WH Hemic and Lymphatic Systems > Hematologic Diseases. Immunologic Factors. Blood Banks > WH 200 Leukocytes. Leukocyte disorders (General)
Faculty: Department: Clinical Sciences & International Health > Clinical Sciences Department
Digital Object Identifer (DOI): https://doi.org/10.1111/tmi.12110
Depositing User: Annmarie Hand
Date Deposited: 20 Dec 2013 09:51
Last Modified: 06 Feb 2018 13:06
URI: http://archive.lstmed.ac.uk/id/eprint/3516

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