Tuberculosis in Hospitalized Patients With Human Immunodeficiency Virus: Clinical Characteristics, Mortality, and Implications From the Rapid Urine-based Screening for Tuberculosis to Reduce AIDS Related Mortality in Hospitalized Patients in Africa

Gupta-Wright, Ankur, Fielding, Katherine, Wilson, Douglas, van Oosterhout, Joep J, Grint, Daniel, Mwandumba, Henry ORCID: https://orcid.org/0000-0003-4470-3608, Alufandika-Moyo, Melanie, Peters, Jurgens A, Chiume, Lingstone, Lawn, Stephen D and Corbett, Elizabeth L (2020) 'Tuberculosis in Hospitalized Patients With Human Immunodeficiency Virus: Clinical Characteristics, Mortality, and Implications From the Rapid Urine-based Screening for Tuberculosis to Reduce AIDS Related Mortality in Hospitalized Patients in Africa'. Clinical Infectious Diseases, Vol 71, Issue 10, pp. 2618-2626.

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Abstract

BACKGROUND
TB is the major killer of people living with HIV globally, with suboptimal diagnostics and management contributing to high case-fatality rates.
METHODS
A prospective cohort of confirmed (Xpert MTB/RIF and/or Determine TB-LAM Ag positive) TB patients identified through screening HIV-positive inpatients with sputum and urine diagnostics in Malawi and South Africa (STAMP trial). Urine was tested prospectively (intervention) or retrospectively (standard of care arm). We defined baseline clinical phenotypes using hierarchical cluster analysis, and also used Cox regression analysis to identify associations with early mortality (≤56 days).

RESULTS

Of 322 patients with TB confirmed between October 2015 and September 2018, 78.0% had ≥1 positive urine test. Antiretroviral therapy (ART) coverage was 80.2% among those not newly diagnosed, but with median CD4 count 75 cells/µL and high HIV viral loads. Early mortality was 30.7% (99/322), despite near-universal prompt TB treatment. Older age, male sex, ART before admission, poor nutritional status, lower haemoglobin, and positive urine tests (TB-LAM and/or Xpert MTB/RIF) were associated with increased mortality in multivariate analyses. Cluster analysis (on baseline variables) defined 4 patient subgroups with early mortality ranging from 9.8% to 52.5%. Although unadjusted mortality was 9.3% lower in South Africa than Malawi, in adjusted models mortality was similar in both countries (HR 0.9, p=0.729).
CONCLUSIONS
Mortality following prompt inpatient diagnosis of HIV-associated TB remained unacceptably high, even in South Africa. Intensified management strategies are urgently needed, for which prognostic indicators could potentially guide both development and subsequent use.

Item Type:	Article
Subjects:	QV Pharmacology > Drug Standardization. Pharmacognosy. Medicinal Plants > QV 771 Standardization and evaluation of drugs 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)
Faculty: Department:	Clinical Sciences & International Health > Clinical Sciences Department
Digital Object Identifer (DOI):	https://doi.org/10.1093/cid/ciz1133
Depositing User:	Julie Franco
Date Deposited:	05 Dec 2019 16:58
Last Modified:	06 Apr 2021 14:30
URI:	https://archive.lstmed.ac.uk/id/eprint/13261

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