Impact of HIV on mortality among patients treated for tuberculosis in Lima, Peru: a prospective cohort study

Details

• Alternative Title:
  BMC Infect Dis
• Personal Author:
  Velásquez, Gustavo E. ; Cegielski, J. Peter ; Murray, Megan B. ; Yagui, Martin J. A. ; Asencios, Luis L. ; Bayona, Jaime N. ; Bonilla, César A. ; Jave, Hector O. ; Yale, Gloria ; Suárez, Carmen Z. ; Sanchez, Eduardo ; Rojas, Christian ; Atwood, Sidney S. ; Contreras, Carmen C. ; Cruz, Janeth Santa ; Shin, Sonya S. ; Velásquez, Gustavo E. ; Cegielski, J. Peter ; Murray, Megan B. ; Yagui, Martin J. A. ; Asencios, Luis L. ; Bayona, Jaime N. ; Bonilla, César A. ; Jave, Hector O. ; Yale, Gloria ; Suárez, Carmen Z. ; Sanchez, Eduardo ; Rojas, Christian ; Atwood, Sidney S. ; Contreras, Carmen C. ; Cruz, Janeth Santa ; Shin, Sonya S.
• Description:
  Background
  
  Human immunodeficiency virus (HIV)-associated tuberculosis deaths have decreased worldwide over the past decade. We sought to evaluate the effect of HIV status on tuberculosis mortality among patients undergoing treatment for tuberculosis in Lima, Peru, a low HIV prevalence setting.
  
  Methods
  
  We conducted a prospective cohort study of patients treated for tuberculosis between 2005 and 2008 in two adjacent health regions in Lima, Peru (Lima Ciudad and Lima Este). We constructed a multivariate Cox proportional hazards model to evaluate the effect of HIV status on mortality during tuberculosis treatment.
  
  Results
  
  Of 1701 participants treated for tuberculosis, 136 (8.0 %) died during tuberculosis treatment. HIV-positive patients constituted 11.0 % of the cohort and contributed to 34.6 % of all deaths. HIV-positive patients were significantly more likely to die (25.1 vs. 5.9 %, P < 0.001) and less likely to be cured (28.3 vs. 39.4 %, P = 0.003). On multivariate analysis, positive HIV status (hazard ratio [HR] = 6.06; 95 % confidence interval [CI], 3.96–9.27), unemployment (HR = 2.24; 95 % CI, 1.55–3.25), and sputum acid-fast bacilli smear positivity (HR = 1.91; 95 % CI, 1.10–3.31) were significantly associated with a higher hazard of death.
  
  Conclusions
  
  We demonstrate that positive HIV status was a strong predictor of mortality among patients treated for tuberculosis in the early years after Peru started providing free antiretroviral therapy. As HIV diagnosis and antiretroviral therapy provision are more widely implemented for tuberculosis patients in Peru, future operational research should document the changing profile of HIV-associated tuberculosis mortality.
  
  
• Subjects:
  Adult Female HIV Infections Humans Male Middle Aged Multivariate Analysis Prevalence Proportional Hazards Models Prospective Studies Tuberculosis Young Adult

  More +
• Source:
  BMC Infect Dis. 16. ; BMC Infect Dis. 16.
• Pubmed ID:
  26831140
• Pubmed Central ID:
  PMC4736097
• Document Type:
  Journal Article
• Funding:
  L30 AI120170/AI/NIAID NIH HHS/United States ; T32 AI007433/AI/NIAID NIH HHS/United States
• Place as Subject:
  Peru
• Volume:
  16
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:9a3af7c75614a51bd94d2a0e76b4ae8305ac8b32e2b79216f5cd9ed22cf5b49e
• Download URL:
  https://stacks.cdc.gov/view/cdc/38117/cdc_38117_DS1.pdf
• File Type:
  [PDF - 546.61 KB ]