1. Treatment Complexities Among Patients with Tuberculosis in a High HIV Prevalence Cohort in the United States.
- Author
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Bizune DJ, Kempker RR, Kagei M, Yamin A, Mohamed O, Holland DP, Oladele A, Wang YF, Rebolledo PA, Blumberg HM, Ray SM, and Schechter MC
- Subjects
- AIDS-Related Opportunistic Infections virology, Adult, Antitubercular Agents adverse effects, Female, Follow-Up Studies, Georgia epidemiology, HIV, Humans, Lost to Follow-Up, Male, Middle Aged, Mycobacterium tuberculosis isolation & purification, Patient Readmission, Prevalence, Recurrence, Retrospective Studies, Treatment Outcome, Tuberculosis mortality, Tuberculosis virology, AIDS-Related Opportunistic Infections epidemiology, Antitubercular Agents therapeutic use, Coinfection drug therapy, Mycobacterium tuberculosis genetics, Tuberculosis drug therapy
- Abstract
The association between human immunodeficiency virus (HIV) infection and tuberculosis (TB) mortality has been studied extensively, but the impact of HIV on other clinically relevant aspects of TB care such as TB drug-related adverse events (AEs), hospital readmissions, and TB treatment duration is less well characterized. We describe the association of HIV infection with TB clinical complexities and outcomes in a high HIV prevalence cohort in the United States. This is a retrospective cohort study among patients treated for culture-confirmed TB between 2008 and 2015 at an inner-city hospital in Atlanta, GA. Univariate analysis was used to estimate association of HIV with TB treatment interruption due to AEs, hospital readmissions, and treatment duration. Final unfavorable TB treatment outcome was defined as death, loss to follow-up, or recurrent TB. Logistic regression modeling was used to estimate association of HIV with final unfavorable outcomes. Among 274 patients with TB, 96 (35%) had HIV coinfection. HIV-positive patients had more TB treatment interruptions due to AE (34% vs. 15%), were more likely to have a hospital readmission (50% vs. 21%), and received longer TB treatment (9.9 months vs. 8.8 months) compared to HIV-negative patients ( p < .01 for all). HIV infection was not associated with final unfavorable outcomes in univariate [odds ratio (OR) = 1.86; confidence interval (95% CI) 0.99-3.49] or multivariate analysis (aOR = 1.13; 95% CI 0.52-2.39) ( p ≥ .05 for both). While HIV infection was not associated with final unfavorable TB outcomes, TB/HIV coinfected patients had more complex treatment course underscoring the importance of maintaining resources and expertise to treat coinfected patients in our and similar settings.
- Published
- 2018
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