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

Gustavo E. Velásquez; J. Peter Cegielski; Megan B. Murray; Martin J.A. Yagui; Luis L. Asencios; Jaime N. Bayona; César A. Bonilla; Hector O. Jave; Gloria Yale; Carmen Z. Suárez; Eduardo Sanchez; Christian Rojas; Sidney S. Atwood; Carmen C. Contreras; Janeth Santa Cruz; Sonya S. Shin

doi:10.1186/s12879-016-1375-8

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

Gustavo E. Velásquez, J. Peter Cegielski, Megan B. Murray, Martin J.A. Yagui, Luis L. Asencios, Jaime N. Bayona, César A. Bonilla, Hector O. Jave, Gloria Yale, Carmen Z. Suárez, Eduardo Sanchez, Christian Rojas, Sidney S. Atwood, Carmen C. Contreras, Janeth Santa Cruz, Sonya S. Shin

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3 Scopus citations

Abstract

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.

Original language	English
Article number	45
Journal	BMC Infectious Diseases
Volume	16
Issue number	1
DOIs	https://doi.org/10.1186/s12879-016-1375-8
State	Published - 1 Feb 2016

Bibliographical note

Funding Information:
This publication was supported by the Bill and Melinda Gates Foundation; the U.S. Centers for Disease Control and Prevention; the National Institute of Allergy and Infectious Diseases at the National Institutes of Health (grant numbers K23 AI054591 to SSS and T32 AI007433 to GEV); the Infectious Diseases Society of America; and the Heiser Foundation. GEV received support for publication costs from the Division of Global Health Equity at Brigham and Women’s Hospital. The content is solely the responsibility of the authors and does not necessarily represent the official views of the U.S. Centers for Disease Control and Prevention, the National Institutes of Health, or the institutions with which the authors are affiliated. The funding sources played no role in the design, collection, analysis, or interpretation of data; in the writing of the manuscript; or in the decision to submit the manuscript for publication.

Publisher Copyright:
© 2016 Velásquez et al.

Keywords

Clinical outcomes
Human immunodeficiency virus
Mortality
Operational research
Prospective cohort study
Tuberculosis

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Velásquez, G. E., Cegielski, J. P., Murray, M. B., Yagui, M. J. A., Asencios, L. L., Bayona, J. N., Bonilla, C. A., Jave, H. O., Yale, G., Suárez, C. Z., Sanchez, E., Rojas, C., Atwood, S. S., Contreras, C. C., Cruz, J. S., & Shin, S. S. (2016). Impact of HIV on mortality among patients treated for tuberculosis in Lima, Peru: A prospective cohort study. BMC Infectious Diseases, 16(1), [45]. https://doi.org/10.1186/s12879-016-1375-8

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title = "Impact of HIV on mortality among patients treated for tuberculosis in Lima, Peru: A prospective cohort study",

abstract = "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.",

keywords = "Clinical outcomes, Human immunodeficiency virus, Mortality, Operational research, Prospective cohort study, Tuberculosis",

author = "Vel{\'a}squez, {Gustavo E.} and Cegielski, {J. Peter} and Murray, {Megan B.} and Yagui, {Martin J.A.} and Asencios, {Luis L.} and Bayona, {Jaime N.} and Bonilla, {C{\'e}sar A.} and Jave, {Hector O.} and Gloria Yale and Su{\'a}rez, {Carmen Z.} and Eduardo Sanchez and Christian Rojas and Atwood, {Sidney S.} and Contreras, {Carmen C.} and Cruz, {Janeth Santa} and Shin, {Sonya S.}",

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Velásquez, GE, Cegielski, JP, Murray, MB, Yagui, MJA, Asencios, LL, Bayona, JN, Bonilla, CA, Jave, HO, Yale, G, Suárez, CZ, Sanchez, E, Rojas, C, Atwood, SS, Contreras, CC, Cruz, JS & Shin, SS 2016, 'Impact of HIV on mortality among patients treated for tuberculosis in Lima, Peru: A prospective cohort study', BMC Infectious Diseases, vol. 16, no. 1, 45. https://doi.org/10.1186/s12879-016-1375-8

TY - JOUR

T1 - Impact of HIV on mortality among patients treated for tuberculosis in Lima, Peru

T2 - A prospective cohort study

AU - Velásquez, Gustavo E.

AU - Cegielski, J. Peter

AU - Murray, Megan B.

AU - Yagui, Martin J.A.

AU - Asencios, Luis L.

AU - Bayona, Jaime N.

AU - Bonilla, César A.

AU - Jave, Hector O.

AU - Yale, Gloria

AU - Suárez, Carmen Z.

AU - Sanchez, Eduardo

AU - Rojas, Christian

AU - Atwood, Sidney S.

AU - Contreras, Carmen C.

AU - Cruz, Janeth Santa

AU - Shin, Sonya S.

PY - 2016/2/1

Y1 - 2016/2/1

N2 - 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.

AB - 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.

KW - Clinical outcomes

KW - Human immunodeficiency virus

KW - Mortality

KW - Operational research

KW - Prospective cohort study

KW - Tuberculosis

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U2 - 10.1186/s12879-016-1375-8

DO - 10.1186/s12879-016-1375-8

M3 - Artículo

C2 - 26831140

AN - SCOPUS:84957965996

SN - 1471-2334

VL - 16

JO - BMC Infectious Diseases

JF - BMC Infectious Diseases

IS - 1

M1 - 45

ER -

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

Abstract

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Keywords

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