Tuberculosis Transmission or Mortality among Persons Living with HIV, United States, 2011–2016

Details

• Alternative Title:
  J Racial Ethn Health Disparities
• Personal Author:
  Schmit, KM ; Shah, N ; Kammerer, S ; Marks, SM ; Bamrah, Morris S
• Description:
  Background:
  
  Persons living with HIV are more likely to have tuberculosis (TB) disease attributed to recent transmission (RT) and to die during TB treatment than persons without HIV. We examined factors associated with RT or mortality among TB/HIV patients.
  
  Methods:
  
  Using National TB Surveillance System data from 2011–2016, we calculated multivariable adjusted odds ratios (aOR) with 99% confidence intervals (CI) to estimate associations between patient characteristics and RT or mortality. Mortality analyses were restricted to 2011–2014 to allow sufficient time for reporting outcomes.
  
  Results:
  
  TB disease was attributed to RT in 491 (20%) of 2,415 TB/HIV patients. RT was more likely among those reporting homelessness (aOR:2.6, CI:2.0,3.5) or substance use (aOR:1.6, CI:1.2,2.1), and among blacks (aOR:1.8, CI:1.2,2.8) and Hispanics (aOR:1.8, CI:1.1,2.9); RT was less likely among non-U.S.–born persons (aOR:0.2, CI:0.2,0.3). The proportion who died during TB treatment was higher among persons with HIV than without (8.6% versus 5.2%; p<.0001). Among 2,273 TB/HIV patients, 195 died during TB treatment. Age ≥65 years (aOR:5.3, CI:2.4,11.6), 45–64 years (aOR:2.2, CI:1.4,3.4), and having another medical risk factor for TB (aOR:3.3, CI:1.8,6.2) were associated with death; directly observed treatment (DOT) for TB was protective (aOR:0.5, CI:0.2,1.0).
  
  Conclusions:
  
  Among TB/HIV patients, blacks, Hispanics, and those reporting homelessness or substance use should be prioritized for interventions that decrease TB transmission. Improved adherence to treatment through DOT was associated with decreased mortality, but additional interventions are needed to reduce mortality among older patients and those TB/HIV patients with another medical risk factor for TB.
  
  
• Keywords:
  Adolescent Adult Aged Female HIV HIV Infections Humans Male Middle Aged Mortality Risk Factors Transmission Tuberculosis United States Young Adult

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• Source:
  J Racial Ethn Health Disparities. 7(5):865-873
• Pubmed ID:
  32060748
• Pubmed Central ID:
  PMC7918278
• Document Type:
  Journal Article
• Funding:
  CC999999/ImCDC/Intramural CDC HHSUnited States/ ; n/a/CC/CDC HHSUnited States/
• Volume:
  7
• Issue:
  5
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:09d18aa2df3eaa8f26e765d7711deff217d1ef6b4103aebf3382d265e4481feb
• Download URL:
  https://stacks.cdc.gov/view/cdc/103643/cdc_103643_DS1.pdf
• File Type:
  [PDF - 343.60 KB ]