Immunological non-response and low hemoglobin levels are predictors of incident tuberculosis among HIV-infected individuals on Truvada-based therapy in Botswana.
BACKGROUND:There is a high burden of tuberculosis (TB) in HIV antiretroviral programmes in Africa. However, few studies have looked at predictors of incident TB while on Truvada-based combination antiretroviral therapy (cART) regimens. METHODS:We estimated TB incidence among individuals enrolled int...
| Main Authors: | , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Public Library of Science (PLoS)
2018-01-01
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| Series: | PLoS ONE |
| Online Access: | http://europepmc.org/articles/PMC5792012?pdf=render |
| _version_ | 1819108560976478208 |
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| author | Lucy Mupfumi Sikhulile Moyo Kesaobaka Molebatsi Prisca K Thami Motswedi Anderson Tuelo Mogashoa Thato Iketleng Joseph Makhema Richard Marlink Ishmael Kasvosve Max Essex Rosemary M Musonda Simani Gaseitsiwe |
| author_facet | Lucy Mupfumi Sikhulile Moyo Kesaobaka Molebatsi Prisca K Thami Motswedi Anderson Tuelo Mogashoa Thato Iketleng Joseph Makhema Richard Marlink Ishmael Kasvosve Max Essex Rosemary M Musonda Simani Gaseitsiwe |
| author_sort | Lucy Mupfumi |
| collection | DOAJ |
| description | BACKGROUND:There is a high burden of tuberculosis (TB) in HIV antiretroviral programmes in Africa. However, few studies have looked at predictors of incident TB while on Truvada-based combination antiretroviral therapy (cART) regimens. METHODS:We estimated TB incidence among individuals enrolled into an observational cohort evaluating the efficacy and tolerability of Truvada-based cART in Gaborone, Botswana between 2008 and 2011. We used Cox proportional hazards regressions to determine predictors of incident TB. RESULTS:Of 300 participants enrolled, 45 (15%) had a diagnosis of TB at baseline. During 428 person-years (py) of follow-up, the incidence rate of TB was 3.04/100py (95% CI, 1.69-5.06), with 60% of the cases occurring within 3 months of ART initiation. Incident cases had low baseline CD4+ T cell counts (153cells/mm3 [Q1, Q3: 82, 242]; p = 0.69) and hemoglobin levels (9.2g/dl [Q1, Q3: 8.5,10.1]; p<0.01). In univariate analysis, low BMI (HR = 0.73; 95% CI 0.58-0.91; p = 0.01) and hemoglobin levels <8 g/dl (HR = 10.84; 95%CI: 2.99-40.06; p<0.01) were risk factors for TB. Time to incident TB diagnosis was significantly reduced in patients with poor immunological recovery (p = 0.04). There was no association between baseline viral load and risk of TB (HR = 1.75; 95%CI: 0.70-4.37). CONCLUSION:Low hemoglobin levels prior to initiation of ART are significant predictors of incident tuberculosis. Therefore, there is potential utility of iron biomarkers to identify patients at risk of TB prior to initiation on ART. Furthermore, additional strategies are required for patients with poor immunological recovery to reduce excess risk of TB while on ART. |
| first_indexed | 2024-12-22T03:11:53Z |
| format | Article |
| id | doaj.art-04b31d06fd594e3da7e8fc798dc4e1d6 |
| institution | Directory Open Access Journal |
| issn | 1932-6203 |
| language | English |
| last_indexed | 2024-12-22T03:11:53Z |
| publishDate | 2018-01-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLoS ONE |
| spelling | doaj.art-04b31d06fd594e3da7e8fc798dc4e1d62022-12-21T18:40:54ZengPublic Library of Science (PLoS)PLoS ONE1932-62032018-01-01131e019203010.1371/journal.pone.0192030Immunological non-response and low hemoglobin levels are predictors of incident tuberculosis among HIV-infected individuals on Truvada-based therapy in Botswana.Lucy MupfumiSikhulile MoyoKesaobaka MolebatsiPrisca K ThamiMotswedi AndersonTuelo MogashoaThato IketlengJoseph MakhemaRichard MarlinkIshmael KasvosveMax EssexRosemary M MusondaSimani GaseitsiweBACKGROUND:There is a high burden of tuberculosis (TB) in HIV antiretroviral programmes in Africa. However, few studies have looked at predictors of incident TB while on Truvada-based combination antiretroviral therapy (cART) regimens. METHODS:We estimated TB incidence among individuals enrolled into an observational cohort evaluating the efficacy and tolerability of Truvada-based cART in Gaborone, Botswana between 2008 and 2011. We used Cox proportional hazards regressions to determine predictors of incident TB. RESULTS:Of 300 participants enrolled, 45 (15%) had a diagnosis of TB at baseline. During 428 person-years (py) of follow-up, the incidence rate of TB was 3.04/100py (95% CI, 1.69-5.06), with 60% of the cases occurring within 3 months of ART initiation. Incident cases had low baseline CD4+ T cell counts (153cells/mm3 [Q1, Q3: 82, 242]; p = 0.69) and hemoglobin levels (9.2g/dl [Q1, Q3: 8.5,10.1]; p<0.01). In univariate analysis, low BMI (HR = 0.73; 95% CI 0.58-0.91; p = 0.01) and hemoglobin levels <8 g/dl (HR = 10.84; 95%CI: 2.99-40.06; p<0.01) were risk factors for TB. Time to incident TB diagnosis was significantly reduced in patients with poor immunological recovery (p = 0.04). There was no association between baseline viral load and risk of TB (HR = 1.75; 95%CI: 0.70-4.37). CONCLUSION:Low hemoglobin levels prior to initiation of ART are significant predictors of incident tuberculosis. Therefore, there is potential utility of iron biomarkers to identify patients at risk of TB prior to initiation on ART. Furthermore, additional strategies are required for patients with poor immunological recovery to reduce excess risk of TB while on ART.http://europepmc.org/articles/PMC5792012?pdf=render |
| spellingShingle | Lucy Mupfumi Sikhulile Moyo Kesaobaka Molebatsi Prisca K Thami Motswedi Anderson Tuelo Mogashoa Thato Iketleng Joseph Makhema Richard Marlink Ishmael Kasvosve Max Essex Rosemary M Musonda Simani Gaseitsiwe Immunological non-response and low hemoglobin levels are predictors of incident tuberculosis among HIV-infected individuals on Truvada-based therapy in Botswana. PLoS ONE |
| title | Immunological non-response and low hemoglobin levels are predictors of incident tuberculosis among HIV-infected individuals on Truvada-based therapy in Botswana. |
| title_full | Immunological non-response and low hemoglobin levels are predictors of incident tuberculosis among HIV-infected individuals on Truvada-based therapy in Botswana. |
| title_fullStr | Immunological non-response and low hemoglobin levels are predictors of incident tuberculosis among HIV-infected individuals on Truvada-based therapy in Botswana. |
| title_full_unstemmed | Immunological non-response and low hemoglobin levels are predictors of incident tuberculosis among HIV-infected individuals on Truvada-based therapy in Botswana. |
| title_short | Immunological non-response and low hemoglobin levels are predictors of incident tuberculosis among HIV-infected individuals on Truvada-based therapy in Botswana. |
| title_sort | immunological non response and low hemoglobin levels are predictors of incident tuberculosis among hiv infected individuals on truvada based therapy in botswana |
| url | http://europepmc.org/articles/PMC5792012?pdf=render |
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