https://doi.org/10.4081/monaldi.2021.1648
Factors associated with unfavourable treatment outcomes in people with HIV-associated tuberculosis in Armenia, 2015 to 2019
Published: January 14, 2021
Abstract Views: 902
PDF: 539
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Authors
To evaluate factors associated with tuberculosis (TB) treatment outcomes in human Immunodeficiency Virus-Associated (HIV) TB patients in Armenia, we conducted a nation-wide cohort study using routine programmatic data of all HIV-associated TB patients receiving TB treatment with first- or second-line drugs from 2015 to 2019. Data were obtained from the TB and HIV electronic databases. We analysed occurrence of the combined unfavourable outcome (failure, lost to follow-up, death and not evaluated) and death separately, and factors associated with both outcomes using Cox regression. There were 320 HIV-associated TB patients who contributed a total of 351 episodes of TB treatment. An unfavourable TB treatment outcome was registered in 155 (44.2%) episodes, including 85 (24.2%) due to death, 38 (10.8%) lost to follow up, 13 (3.7%) failure and 19 (5.4%) not evaluated. Multivariable analysis showed that receipt of Antiretroviral Treatment (ART) [ART start before TB treatment: adjusted hazard ratio (aHR)=0.3, 95% confidence interval (CI): 0.2-0.5, aHR=, 95% CI:, 95% CI:, 95% CI:TB meningitis (aHR=4.4, 95% CI: 1.6-11.9) increased the risk. The risk of death was affected by the same factors as above in addition to the low BMI (aHR=2.5, 95% CI: 1.3-4.5) and drug resistance (aHR=2.3, 95% CI: 1.0-5.4). In the subsample of episodes receiving ART, history of interruption of ART during TB treatment increased the risk of unfavourable outcome (aHR=2.1 95% CI: 1.2-3.9), while ART start during TB treatment was associated with lower risk of both unfavourable outcome (within first 8 weeks: aHR: 0.5, 95% CI: 0.3-0.9; after 8 weeks: aHR: 0.4, 95% CI: 0.2-1.0) and death (within first 8 weeks: aHR: 0.2, 95% CI: 0.1-0.4; after 8 weeks: aHR: 0.1, 95% CI: 0.01-0.3). The rates of unfavourable TB treatment outcomes, and death in particular, among HIV-associated TB patients in Armenia are high. Our findings emphasize the protective effect of ART and the importance of proper management of cases complicated by drug resistance or meningitis.
WHO. Global tuberculosis report. Geneva: WHO; 2019. Available from: https://www.who.int/tb/publications/global_report/en/
WHO Regional Office for Europe. Tuberculosis surveillance and monitoring report in Europe. 2020. Accessed on: 2020 Jul 1. Available from: https://www.euro.who.int/en/health-topics/communicable-diseases/tuberculosis/publications/2020/tuberculosis-surveillance-and-monitoring-report-in-europe-2020
UNAIDS. Country factsheets Armenia 2018. 2018. Available from: https://www.unaids.org/en/regionscountries/countries/armenia
WHO. WHO consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection. Geneva: WHO; 2016. Accessed on: 2020 Jul 5. Available from: https://apps.who.int/iris/bitstream/handle/10665/208825/9789241549684_eng.pdf?sequence=1&isAllowed=y
WHO. WHO consolidated guidelines on drug-resistant tuberculosis treatment. Geneva: WHO; 2019. Available from: https://www.who.int/tb/publications/2019/consolidated-guidelines-drug-resistant-TB-treatment/en/
Mukuku O, Mutombo AM, Kakisingi CN, et al. Tuberculosis and HIV co-infection in Congolese children: risk factors of death. Pan Afr Med J 2019;33:326.
Gatechompol S, Kawkitinarong K, Suwanpimolkul G, et al. Treatment outcomes and factors associated with mortality among individuals with both TB and HIV in the antiretroviral era in Thailand. J virus Erad 2019;5:225–30.
Demitto FO, Schmaltz CAS, Sant’Anna FM, et al. Predictors of early mortality and effectiveness of antiretroviral therapy in TB-HIV patients from Brazil. PLoS One 2019;14.
WHO. Treatment of tuberculosis guidelines for treatment of drug-susceptible tuberculosis and patient care. Geneva: WHO; 2017. Available from: https://apps.who.int/iris/bitstream/handle/10665/255052/9789241550000-eng.pdf
WHO Regional Office for Europe. HIV programme review in Armenia. Geneva: WHO; 2015. Accessed on: 2020 Aug 11. Available from: https://www.euro.who.int/en/health-topics/communicable-diseases/hivaids/publications/2015/hiv-programme-review-in-armenia-2015
WHO. Update of recommendations on first-and second-line antiretroviral regimens. Geneva: WHO; 2019. Accessed on: 2020 Aug 7. Available from: https://www.who.int/hiv/pub/arv/arv-update-2019-policy/en/
WHO. Definitions and reporting framework for tuberculosis. Accessed on: 2020 Jul 1. Available from: https://www.who.int/tb/publications/definitions/en/
Avaliani Z, Gozalov O, Kuchukhidze G, et al. What is behind programmatic treatment outcome definitions for tuberculosis? Eur Res J 2020;56:2001751. doi: 10.1183/13993003.01751-2020
WHO Regional Office for Europe. Nutrition - Body Mass Index - BMI. Accessed 2020 Jul 8. Available from: https://www.euro.who.int/en/health-topics/disease-prevention/nutrition/a-healthy-lifestyle/body-mass-index-bmi
UNAIDS. 90–90–90 - an ambitious treatment target to help end the AIDS epidemic. Accessed on: 2019 Dec 3. Available from: https://www.unaids.org/en/resources/documents/2017/90-90-90
Tweya H, Feldacker C, Phiri S, et al. Comparison of treatment outcomes of new smear-positive pulmonary tuberculosis patients by HIV and antiretroviral status in a TB/HIV clinic, Malawi. PLoS One 2013;8:e56258.
Nagu TJ, Aboud S, Mwiru R, et al. Tuberculosis associated mortality in a prospective cohort in Sub Saharan Africa: association with HIV and antiretroviral therapy. Int J Infect Dis 2017;56:39–44.
Girardi E, Palmieri F, Angeletti C, et al. Clinical study impact of previous art and of art initiation on outcome of HIV-associated tuberculosis. Clin Dev Immunol 2012;2012:931325.
Kim MH, Song JE, Ahn JY, et al. HIV antiretroviral resistance mutations among antiretroviral treatment-naive and-experienced patients in South Korea. AIDS Res Hum Retroviruses 2013;29:1617–20.
Meintjes G, Rabie H, Wilkinson RJ, et al. Tuberculosis-associated immune reconstitution inflammatory syndrome and unmasking of tuberculosis by antiretroviral therapy. Clin Chest Med 2009;30:797–810.
Gupta A, Nadkarni G, Yang WT, et al. Early mortality in adults initiating Antiretroviral Therapy (ART) in Low- And Middle-Income Countries (LMIC): a systematic review and meta-analysis. PLoS One2011;6:e28691.
Kranzer K, Ford N. Unstructured treatment interruption of antiretroviral therapy in clinical practice: a systematic review. Trop Med Int Heal 2011;16:1297-313.
Teklu AM, Yirdaw KD. Patients who restart antiretroviral medication after interruption remain at high risk of unfavorable outcomes in Ethiopia. BMC Health Serv Res 2017;17:247.
Pormohammad A, Nasiri MJ, Riahi SM, Fallah F. Human immunodeficiency virus in patients with tuberculous meningitis: systematic review and meta-analysis. Trop Med Int Heal 2018;23:589–95.
Efsen AMW, Panteleev Am, Grint D, et al. TB meningitis in HIV-positive patients in Europe and Argentina: clinical outcome and factors associated with mortality. BioMed Res Int 2013;2013:373601.
Rossetto M, Brand ÉM, Rodrigues RM, et al. Factors associated with hospitalization and death among TB/HIV co-infected persons in Porto Alegre, Brazil. PLoS One 2019;14:e0209174.
Migliori GB, Tiberi S, Zumla A, et al. MDR/XDR-TB management of patients and contacts: challenges facing the new decade. The 2020 clinical update by the Global Tuberculosis Network. Int J Infect Dis 2020;92:S15-25.
Langendam MW, van der Werf MJ, Huitric E, et al. Prevalence of inappropriate tuberculosis treatment regimens: a systematic review. Eur Respir J 2012;39:1012-20.
Laushkina Z. The analysis of factors associated with misdiagnosis pneumonia in TB hospital. Eur Res J 2015;46:PA1524.
Laushkina Z, Filimonov P. Misdiagnosed pulmonary TB: influencing factors and diagnostic chances in TB hospital. Eur J Res 2012;40:P2720.
Lai HH, Lai YJ, Yen YF. Association of body mass index with timing of death during tuberculosis treatment. PLoS One 2017;12:e0170104.
Naidoo K, Yende-Zuma N, Augustine S. A retrospective cohort study of body mass index and survival in HIV infected patients with and without TB co-infection. Infect Dis Poverty 2018;7:35.
Sharma A, Hoover DR, Shi Q, et al. Relationship between body mass index and mortality in HIV-infected HAART users in the women’s interagency HIV study. PLoS One 2015;10:e0143740.
Ezeamama AE, Mupere E, Oloya J, et al. Age, sex, and nutritional status modify the cd4+ t-cell recovery rate in HIV-tuberculosis co-infected patients on combination antiretroviral therapy. Int J Infect Dis 2015;35:73-9.
How to Cite
Gevorgyan, Lilit, Ruzanna Grigoryan, Kostyantyn Dumchev, Kristina Akopyan, Anush Khachatryan, Eduard Kabasakalyan, Trdat Grigoryan, et al. 2021. “Factors Associated With Unfavourable Treatment Outcomes in People With HIV-Associated Tuberculosis in Armenia, 2015 to 2019”. Monaldi Archives for Chest Disease 91 (1). https://doi.org/10.4081/monaldi.2021.1648.
PAGEPress has chosen to apply the Creative Commons Attribution NonCommercial 4.0 International License (CC BY-NC 4.0) to all manuscripts to be published.
Similar Articles
- Roberto F.E. Pedretti, Francesco Fattirolli, Raffaele Griffo, Marco Ambrosetti, Elisabetta Angelino, Silvia Brazzo, Ugo Corrà , Nicolò Dasseni, Pompilio Faggiano, Giuseppe Favretto, Oreste Febo, Marina Ferrari, Francesco Giallauria, Cesare Greco, Manuela Iannucci, Maria Teresa La Rovere, Mario Mallardo, Antonio Mazza, Massimo Piepoli, Carmine Riccio, Simonetta Scalvini, Luigi Tavazzi, Pier Luigi Temporelli, Gian Francesco Mureddu, Cardiac Prevention and Rehabilitation “3.0â€: From acute to chronic phase. Position Paper of the ltalian Association for Cardiovascular Prevention and Rehabilitation (GICR-IACPR) , Monaldi Archives for Chest Disease: Vol. 88 No. 3 (2018)
- L.R. Codecasa, M. Ferrarese, V. Penati, C. Lacchini, D. Cirillo, C. Scarparo, P. Piccoli, C. Piersimoni, G.B. Migliori, Comparison of Tuberculin Skin test and Quantiferon immunological assay for latent Tuberculosis infection , Monaldi Archives for Chest Disease: Vol. 63 No. 3 (2005): Pulmonary series
- Marinella Sommaruga, Elisabetta Angelino, Paola Della Porta, Mara Abatello, Giacomo Baiardo, Gianluigi Balestroni, Ornella Bettinardi, Edward Callus, Chiara Ciracì, Ombretta Omodeo, Claudia Rizza, Paolo Michielin, Marco Ambrosetti, Raffaele Griffo, Roberto F.E. Pedretti, Antonia Pierobon, Best practice in psychological activities in cardiovascular prevention and rehabilitation: Position Paper , Monaldi Archives for Chest Disease: Vol. 88 No. 2 (2018)
- Debapriya Maji, Upasna Agarwal, Lokender Kumar, Vinay V, Amit Sharma, Clinicodemographic profile and outcome of tuberculosis treatment in TB-HIV co-infected patients receiving daily ATT under a single window TB-HIV services delivery initiative , Monaldi Archives for Chest Disease: Vol. 93 No. 3 (2023)
- Paolo Ruggeri, Federica Lo Bello, Francesco Nucera, Michele Gaeta, Francesco Monaco, Gaetano Caramori, Giuseppe Girbino, Hereditary hyperhomocysteinemia associated with nephrotic syndrome complicated by artery thrombosis and chronic thromboembolic pulmonary hypertension: A case report , Monaldi Archives for Chest Disease: Vol. 87 No. 3 (2017)
- Vinay V, Sushil Kumar Munjal, Sandeep Jain, Yasir Abdullah V, Arunachalam M, Srinath Shankar Iyer, To investigate the knowledge, attitude and practices regarding tuberculosis case notification among public and private doctors practicing of modern medicine in South Delhi , Monaldi Archives for Chest Disease: Vol. 93 No. 2 (2023)
- I. Blanco, H. Canto, J. Flóres, C. Camblor, V. Cárcaba, F.J. de Serres, S. Janciauskiene, E.F. Bustillo, Long-term augmentation therapy with Alpha-1 Antitrypsin in an MZ-AAT severe persistent asthma , Monaldi Archives for Chest Disease: Vol. 69 No. 4 (2008): Pulmonary series
- J.P. Zellweger, Tobacco and tuberculosis , Monaldi Archives for Chest Disease: Vol. 69 No. 2 (2008): Pulmonary series
- Z. Celebi Sözener, A. Kaya, C. Atasoy, M. Kılıckap, N. Numanoglu, I. Savas, Septic Pulmonary Embolism: three Case Reports , Monaldi Archives for Chest Disease: Vol. 69 No. 2 (2008): Pulmonary series
- S. Contini, G. Raimondi, P. Graziano, C. Saltini, M. Bocchino, Difficult diagnosis of Infliximab-related miliary tuberculosis , Monaldi Archives for Chest Disease: Vol. 61 No. 2 (2004): Pulmonary series
<< < 1 2 3 4 5 6 7 8 9 10 > >>
You may also start an advanced similarity search for this article.
