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Opportunistic disea...
Opportunistic diseases diminish the clinical benefit of immediate antiretroviral therapy in HIV-tuberculosis co-infected adults with low CD4+ cell counts
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- Worodria, William (författare)
- Infect Dis Inst, Kampala, Uganda;Johns Hopkins Univ, Sch Med, Dept Med, Div Infect Dis, Baltimore, MD 21205 USA;Makerere Univ, Coll Hlth Sci, Dept Med, Kampala, Uganda
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- Ssempijja, Victor (författare)
- Leidos Biomed Res Inc, Clin Res Directorate, Clin Monitoring Res Program, NCI Campus Frederick, Frederick, MD USA
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- Hanrahan, Coleen (författare)
- Johns Hopkins Bloomberg Sch Publ Hlth, Dept Epidemiol, Baltimore, MD USA
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- Ssegonja, Richard (författare)
- Uppsala universitet,Socialmedicin/CHAP
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- Muhofwa, Abdallah (författare)
- Infect Dis Inst, Kampala, Uganda
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- Mazapkwe, Doreen (författare)
- Infect Dis Inst, Kampala, Uganda
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- Mayanja-Kizza, Harriet (författare)
- Infect Dis Inst, Kampala, Uganda;Makerere Univ, Coll Hlth Sci, Dept Med, Kampala, Uganda
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- Reynolds, Steven J. (författare)
- Johns Hopkins Univ, Sch Med, Dept Med, Div Infect Dis, Baltimore, MD 21205 USA;Johns Hopkins Bloomberg Sch Publ Hlth, Dept Epidemiol, Baltimore, MD USA;NIAID, Div Intramural Res, NIH, 9000 Rockville Pike, Bethesda, MD 20892 USA
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- Colebunders, Robert (författare)
- Univ Antwerp, Global Hlth Inst, Antwerp, Belgium
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- Manabe, Yukari C. (författare)
- Infect Dis Inst, Kampala, Uganda;Johns Hopkins Univ, Sch Med, Dept Med, Div Infect Dis, Baltimore, MD 21205 USA
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(creator_code:org_t)
- 2018
- 2018
- Engelska.
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Ingår i: AIDS. - 0269-9370 .- 1473-5571. ; 32:15, s. 2141-2149
- Relaterad länk:
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https://urn.kb.se/re...
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https://doi.org/10.1...
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Abstract
Ämnesord
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- Introduction: HIV-tuberculosis (TB) co-infection remains an important cause of mortality in sub-Saharan Africa. Clinical trials have reported early (within 2 weeks of TB therapy) antiretroviral therapy (ART) reduces mortality among HIV-TB co-infected research participants with low CD4(+) cell counts, but this has not been consistently observed. We aimed to evaluate the currentWHO recommendations for ART in HIV-TB co-infected patients on mortality in routine clinical settings.Methods: We compared two cohorts before (2008-2010) and after (2012-2013) policy change on ART timing after TB and examined the effectiveness of early versus delayed ART on mortality in HIV-TB co-infected participants with CD4(+) cell count 100 cells/ml or less. We used inverse probability censoring-weighted Cox models on baseline characteristics to balance the study arms and generated hazard ratios for mortality.Results: Of 356 participants with CD4(+) cell counts 100 cells/ml or less, 180 were in the delayed ART cohorts whereas 176 were in the early ART cohorts. Their median age (32.5 versus 32 years) and baseline CD4(+) cell counts (26.5 versus 26 cells/ml) respectively were similar. There was no difference in mortality rates of both cohorts. The risk of death increased in participants with a positive Cryptococcal antigen (CrAg) test in both the early ART cohort (aHR = 2.6, 95% CI 1.0-6.8; P = 0.045) and the delayed ART cohort (aHR = 4.2, 95% CI 1.9-9.0; P< 0.001Conclusion: Early ART in patients with HIV-TB co-infection was not associated with reduced risk of mortality in routine care. Asymptomatic Cryptococcal antigenaemia increased the risk of mortality in both cohorts.
Ämnesord
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Infektionsmedicin (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Infectious Medicine (hsv//eng)
Nyckelord
- adult
- antiretroviral therapy
- HIV
- mortality
- tuberculosis
Publikations- och innehållstyp
- ref (ämneskategori)
- art (ämneskategori)
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AIDS
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Worodria, Willia ...
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Ssempijja, Victo ...
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Hanrahan, Coleen
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Ssegonja, Richar ...
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Muhofwa, Abdalla ...
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Mazapkwe, Doreen
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visa fler...
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Mayanja-Kizza, H ...
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Reynolds, Steven ...
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Colebunders, Rob ...
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Manabe, Yukari C ...
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- MEDICIN OCH HÄLSOVETENSKAP
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AIDS
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Uppsala universitet