Impact of antiretroviral therapy on the incidence of tuberculosis: the Brazilian experience, 1995-2001. Export

@article{citeulike:1647017, abstract = {BACKGROUND: The human immunodeficiency virus (HIV) fuels tuberculosis (TB) epidemics. In controlled clinical trials, antiretroviral therapy (ART) reduces TB incidence in HIV-infected patients. In this study we determine if, under programmatic conditions, Brazil's policy of universal ART access has impacted TB incidence among HIV-infected patients. METHODS: We abstracted clinical information from records of HIV-infected patients managed in the public sector in 11 Brazilian states between 1/1/1995 and 12/31/2001. Case ascertainment (TB and HIV) utilized guidelines (with added stringency) published by Brazil's Ministry of Health. We determined TB incidence and hazards ratio (HR) for ART-na\"{i}ve and ART-treated [including highly active ART (HAART)] patients employing Cox proportional hazards analysis. RESULTS: Information from 463 HIV-infected patients met study criteria. The median age of the study population was 34 years, 70\% were male, and mean follow-up to primary endpoints--TB, death, and last clinic visit--was 330, 1059, and 1125 days, respectively. Of the 463 patients, 76 (16\%) remained ART-na\"{i}ve. Of the patients who never received HAART (n = 157) 81 were treated with ART non-HAART. Of the patients who received any ART (n = 387), 306 were treated with HAART (includes those patients who later switched from ART non-HAART to HAART). Tuberculosis developed in 39/463 (8\%) patients. Compared to HAART- and ART non-HAART-treated patient groups, TB incidence was 10- (p<0.001) and 2.5-fold (p = 0.03) higher in ART-na\"{i}ve patients, respectively. The median baseline absolute CD4+ T-lymphocyte count for patients who developed TB was not significantly different from that of patients who remained TB free. In multivariate analysis, the incidence of TB was statistically significantly lower in HAART-treated [HR 0.2; 95\% (CI 0.1, 0.6); p<0.01] compared to ART na\"{i}ve patients. A baseline CD4+ T-lymphocyte count <200 cells/mm3 [HR 2.5; (95\% CI 1.2, 5.4); p<0.01], prior hospitalization [HR 4.2; (95\% CI 2.0, 8.8); p<0.001], prior incarceration [HR 4.1; 95\% CI 1.6, 10.3); p<0.01], and a positive tuberculin skin test [HR 3.1; (95\% CI 1.1, 9.0); p = 0.04] were independently and positively associated with incident TB. CONCLUSION: In this population-based study we demonstrate an 80\% reduction in incident TB, under programmatic conditions, in HAART-treated HIV-infected patients compared to ART-na\"{i}ve patients.}, address = {The Global AIDS Program, United States Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America. aci5@cdc.gov}, author = {Miranda, A. and Morgan, M. and Jamal, L. and Laserson, K. and Barreira, D. and Silva, G. and Santos, J. and Wells, C. and Paine, P. and Garrett, D.}, citeulike-article-id = {1647017}, citeulike-linkout-0 = {http://dx.doi.org/10.1371/journal.pone.0000826}, citeulike-linkout-1 = {http://view.ncbi.nlm.nih.gov/pubmed/17786198}, citeulike-linkout-2 = {http://www.hubmed.org/display.cgi?uids=17786198}, doi = {10.1371/journal.pone.0000826}, issn = {1932-6203}, journal = {PLoS ONE}, keywords = {aids, antiretroviral, brazil, haart, hiv, hivaids, tb, therapy, tuberculosis}, number = {9}, posted-at = {2007-09-12 10:21:13}, priority = {2}, title = {Impact of antiretroviral therapy on the incidence of tuberculosis: the Brazilian experience, 1995-2001.}, url = {http://dx.doi.org/10.1371/journal.pone.0000826}, volume = {2}, year = {2007} }

TY - JOUR ID - citeulike:1647017 L3 - citeulike-article-id:1647017 N2 - BACKGROUND: The human immunodeficiency virus (HIV) fuels tuberculosis (TB) epidemics. In controlled clinical trials, antiretroviral therapy (ART) reduces TB incidence in HIV-infected patients. In this study we determine if, under programmatic conditions, Brazil's policy of universal ART access has impacted TB incidence among HIV-infected patients. METHODS: We abstracted clinical information from records of HIV-infected patients managed in the public sector in 11 Brazilian states between 1/1/1995 and 12/31/2001. Case ascertainment (TB and HIV) utilized guidelines (with added stringency) published by Brazil's Ministry of Health. We determined TB incidence and hazards ratio (HR) for ART-naïve and ART-treated [including highly active ART (HAART)] patients employing Cox proportional hazards analysis. RESULTS: Information from 463 HIV-infected patients met study criteria. The median age of the study population was 34 years, 70% were male, and mean follow-up to primary endpoints--TB, death, and last clinic visit--was 330, 1059, and 1125 days, respectively. Of the 463 patients, 76 (16%) remained ART-naïve. Of the patients who never received HAART (n = 157) 81 were treated with ART non-HAART. Of the patients who received any ART (n = 387), 306 were treated with HAART (includes those patients who later switched from ART non-HAART to HAART). Tuberculosis developed in 39/463 (8%) patients. Compared to HAART- and ART non-HAART-treated patient groups, TB incidence was 10- (p<0.001) and 2.5-fold (p = 0.03) higher in ART-naïve patients, respectively. The median baseline absolute CD4+ T-lymphocyte count for patients who developed TB was not significantly different from that of patients who remained TB free. In multivariate analysis, the incidence of TB was statistically significantly lower in HAART-treated [HR 0.2; 95% (CI 0.1, 0.6); p<0.01] compared to ART naïve patients. A baseline CD4+ T-lymphocyte count <200 cells/mm3 [HR 2.5; (95% CI 1.2, 5.4); p<0.01], prior hospitalization [HR 4.2; (95% CI 2.0, 8.8); p<0.001], prior incarceration [HR 4.1; 95% CI 1.6, 10.3); p<0.01], and a positive tuberculin skin test [HR 3.1; (95% CI 1.1, 9.0); p = 0.04] were independently and positively associated with incident TB. CONCLUSION: In this population-based study we demonstrate an 80% reduction in incident TB, under programmatic conditions, in HAART-treated HIV-infected patients compared to ART-naïve patients. IS - 9 JF - PLoS ONE SN - 1932-6203 AD - The Global AIDS Program, United States Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America. aci5@cdc.gov TI - Impact of antiretroviral therapy on the incidence of tuberculosis: the Brazilian experience, 1995-2001. VL - 2 KW - aids KW - antiretroviral KW - brazil KW - haart KW - hiv KW - hivaids KW - tb KW - therapy KW - tuberculosis AU - Miranda, A AU - Morgan, M AU - Jamal, L AU - Laserson, K AU - Barreira, D AU - Silva, G AU - Santos, J AU - Wells, C AU - Paine, P AU - Garrett, D PY - 2007/// UR - http://dx.doi.org/10.1371/journal.pone.0000826 ER -