HIV and Tuberculosis in Atlanta, GA: Antiretroviral Therapy Uptake and Factors Associated with Unfavorable Outcomes
By Destani J. Bizune
Background: We investigated antiretroviral therapy (ART) uptake and the association of HIV and unfavorable treatment outcomes among patients with culture-confirmed tuberculosis at Grady Memorial Hospital (GMH), a safety net hospital in Atlanta, GA.
Methods: Retrospective cohort study of patients with culture-confirmed TB admitted to GMH from 2008-15. We compared baseline characteristics between HIV-positive and negative patients. Factors associated with unfavorable outcomes during TB treatment were analyzed using multivariate logistic regression.
Results: Among 271 patients, 95 (35%) were HIV-positive; 23 (24%) of whom were newly diagnosed at the time of TB diagnosis. The 72 patients with known HIV were diagnosed a median of 6 years prior to developing TB, and only 11 (15%) were receiving ART at presentation. Most HIV patients (67%) had a baseline CD4 count ≤ 200 cells/mm3. Fifty-six (67%) of eligible HIV-infected patients were started on ART after TB diagnosis and median days from TB treatment to ART initiation was 81 days (IQR 34 - 118). Most patients were male (75%), black (81%), and median age was 47 years. Almost half the patients (44%) had a history of homelessness. Patients with HIV were more likely to have disseminated disease and complications during treatment, including a higher rate of isoniazid resistance, extrapulmonary involvement, adverse side effects, and hospital readmissions. Overall, 36 (14%) patients died during TB treatment, 17 (47%) of whom were HIV-positive. While the death rate was higher in HIV (19%) vs. non-HIV (11%) TB patients, the difference was non-significant (p = 0.26). In multivariate analysis, disseminated and CNS disease were associated with unfavorable outcome while HIV was not (aOR 1.31, 95% CI 0.63 - 2.74, p = 0.47).
Conclusions: The majority of patients with TB/HIV co-infection in this cohort had known HIV infection before TB diagnosis and were not receiving ART. Additionally, a substantial proportion of co-infected patients did not start ART within a recommended time period. There was no significant association with HIV infection and mortality, but HIV-infected patients had more complications during treatment and higher rates of disseminated disease. Interventions to increase linkage to HIV care are needed and could contribute to TB control in Atlanta.
Table of Contents
Figure 1: Study Population diagram
Figure 3: Survival Probability Plot
Table 1: Baseline characteristics by HIV status
Table 2: HIV descriptive statistics
Table 3: Outcomes
Table 4: Bivariate analysis for culture conversion
Table 5: Univariate and multivariate analysis
Table 6 - Univariate associations with unfavorable outcome
Table 7 - Multivariate associations with unfavorable outcome
Supplemental Table 1: Alternative model
About this Master's Thesis
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|HIV and Tuberculosis in Atlanta, GA: Antiretroviral Therapy Uptake and Factors Associated with Unfavorable Outcomes ()||2018-08-28||