Incidence and predictors of tuberculosis among HIV-infected adults after initiation of antiretroviral therapy in Nigeria, 2004-2012.
BACKGROUND:Nigeria had the most AIDS-related deaths worldwide in 2014 (170,000), and 46% were associated with tuberculosis (TB). Although treatment of people living with HIV (PLHIV) with antiretroviral therapy (ART) reduces TB-associated morbidity and mortality, incident TB can occur while on ART. W...
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| Format: | Article |
| Language: | English |
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Public Library of Science (PLoS)
2017-01-01
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| Series: | PLoS ONE |
| Online Access: | http://europepmc.org/articles/PMC5345814?pdf=render |
| _version_ | 1819030413661700096 |
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| author | Ishani Pathmanathan E Kainne Dokubo Ray W Shiraishi Simon G Agolory Andrew F Auld Dennis Onotu Solomon Odafe Ibrahim Dalhatu Oseni Abiri Henry C Debem Adebobola Bashorun Tedd Ellerbrock |
| author_facet | Ishani Pathmanathan E Kainne Dokubo Ray W Shiraishi Simon G Agolory Andrew F Auld Dennis Onotu Solomon Odafe Ibrahim Dalhatu Oseni Abiri Henry C Debem Adebobola Bashorun Tedd Ellerbrock |
| author_sort | Ishani Pathmanathan |
| collection | DOAJ |
| description | BACKGROUND:Nigeria had the most AIDS-related deaths worldwide in 2014 (170,000), and 46% were associated with tuberculosis (TB). Although treatment of people living with HIV (PLHIV) with antiretroviral therapy (ART) reduces TB-associated morbidity and mortality, incident TB can occur while on ART. We estimated incidence and characterized factors associated with TB after ART initiation in Nigeria. METHODS:We analyzed retrospective cohort data from a nationally representative sample of adult patients on ART. Data were abstracted from 3,496 patient records, and analyses were weighted and controlled for a complex survey design. We performed domain analyses on patients without documented TB disease and used a Cox proportional hazard model to assess factors associated with TB incidence after ART. RESULTS:At ART initiation, 3,350 patients (95.8%) were not receiving TB treatment. TB incidence after ART initiation was 0.57 per 100 person-years, and significantly higher for patients with CD4<50/μL (adjusted hazard ratio [AHR]: 4.2, 95% confidence interval [CI]: 1.4-12.7) compared with CD4≥200/μL. Patients with suspected but untreated TB at ART initiation and those with a history of prior TB were more likely to develop incident TB (AHR: 12.2, 95% CI: 4.5-33.5 and AHR: 17.6, 95% CI: 3.5-87.9, respectively). CONCLUSION:Incidence of TB among PLHIV after ART initiation was low, and predicted by advanced HIV, prior TB, and suspected but untreated TB. Study results suggest a need for improved TB screening and diagnosis, particularly among high-risk PLHIV initiating ART, and reinforce the benefit of early ART and other TB prevention efforts. |
| first_indexed | 2024-12-21T06:29:46Z |
| format | Article |
| id | doaj.art-0f41bff94d8945f5808ae77c4592fcd6 |
| institution | Directory Open Access Journal |
| issn | 1932-6203 |
| language | English |
| last_indexed | 2024-12-21T06:29:46Z |
| publishDate | 2017-01-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLoS ONE |
| spelling | doaj.art-0f41bff94d8945f5808ae77c4592fcd62022-12-21T19:13:01ZengPublic Library of Science (PLoS)PLoS ONE1932-62032017-01-01123e017330910.1371/journal.pone.0173309Incidence and predictors of tuberculosis among HIV-infected adults after initiation of antiretroviral therapy in Nigeria, 2004-2012.Ishani PathmanathanE Kainne DokuboRay W ShiraishiSimon G AgoloryAndrew F AuldDennis OnotuSolomon OdafeIbrahim DalhatuOseni AbiriHenry C DebemAdebobola BashorunTedd EllerbrockBACKGROUND:Nigeria had the most AIDS-related deaths worldwide in 2014 (170,000), and 46% were associated with tuberculosis (TB). Although treatment of people living with HIV (PLHIV) with antiretroviral therapy (ART) reduces TB-associated morbidity and mortality, incident TB can occur while on ART. We estimated incidence and characterized factors associated with TB after ART initiation in Nigeria. METHODS:We analyzed retrospective cohort data from a nationally representative sample of adult patients on ART. Data were abstracted from 3,496 patient records, and analyses were weighted and controlled for a complex survey design. We performed domain analyses on patients without documented TB disease and used a Cox proportional hazard model to assess factors associated with TB incidence after ART. RESULTS:At ART initiation, 3,350 patients (95.8%) were not receiving TB treatment. TB incidence after ART initiation was 0.57 per 100 person-years, and significantly higher for patients with CD4<50/μL (adjusted hazard ratio [AHR]: 4.2, 95% confidence interval [CI]: 1.4-12.7) compared with CD4≥200/μL. Patients with suspected but untreated TB at ART initiation and those with a history of prior TB were more likely to develop incident TB (AHR: 12.2, 95% CI: 4.5-33.5 and AHR: 17.6, 95% CI: 3.5-87.9, respectively). CONCLUSION:Incidence of TB among PLHIV after ART initiation was low, and predicted by advanced HIV, prior TB, and suspected but untreated TB. Study results suggest a need for improved TB screening and diagnosis, particularly among high-risk PLHIV initiating ART, and reinforce the benefit of early ART and other TB prevention efforts.http://europepmc.org/articles/PMC5345814?pdf=render |
| spellingShingle | Ishani Pathmanathan E Kainne Dokubo Ray W Shiraishi Simon G Agolory Andrew F Auld Dennis Onotu Solomon Odafe Ibrahim Dalhatu Oseni Abiri Henry C Debem Adebobola Bashorun Tedd Ellerbrock Incidence and predictors of tuberculosis among HIV-infected adults after initiation of antiretroviral therapy in Nigeria, 2004-2012. PLoS ONE |
| title | Incidence and predictors of tuberculosis among HIV-infected adults after initiation of antiretroviral therapy in Nigeria, 2004-2012. |
| title_full | Incidence and predictors of tuberculosis among HIV-infected adults after initiation of antiretroviral therapy in Nigeria, 2004-2012. |
| title_fullStr | Incidence and predictors of tuberculosis among HIV-infected adults after initiation of antiretroviral therapy in Nigeria, 2004-2012. |
| title_full_unstemmed | Incidence and predictors of tuberculosis among HIV-infected adults after initiation of antiretroviral therapy in Nigeria, 2004-2012. |
| title_short | Incidence and predictors of tuberculosis among HIV-infected adults after initiation of antiretroviral therapy in Nigeria, 2004-2012. |
| title_sort | incidence and predictors of tuberculosis among hiv infected adults after initiation of antiretroviral therapy in nigeria 2004 2012 |
| url | http://europepmc.org/articles/PMC5345814?pdf=render |
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