Document Detail


Reducing deaths from tuberculosis in antiretroviral treatment programmes in sub-Saharan Africa.
MedLine Citation:
PMID:  22695302     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Mortality rates are high in antiretroviral therapy (ART) programmes in sub-Saharan Africa, especially during the first few months of treatment. Tuberculosis (TB) has been identified as a major underlying cause. Under routine programme conditions, between 5 and 40% of adult patients enrolling in ART services have a baseline diagnosis of TB. There is also a high TB incidence during the first few months of ART (much of which is prevalent disease missed by baseline screening) and long-term rates remain several-folds higher than background. We identify three groups of patients entering ART programmes for which different interventions are required to reduce TB-related deaths. First, diagnostic screening is needed in patients who have undiagnosed active TB so that timely anti-TB treatment can be started. This may be greatly facilitated by new diagnostic assays such as the Xpert MTB/RIF assay. Second, patients with a diagnosis of active TB need optimized case management, which includes early initiation of ART (with timing now defined by randomized controlled trials), trimethoprim-sulphamethoxazole prophylaxis and treatment of comorbidity. Third, all remaining patients who are TB-free at enrolment have high ongoing risk of developing TB and require preventive interventions, including optimized immune recovery (with ART ideally started early in the course of HIV infection), isoniazid preventive therapy and infection control to reduce infection risk. Further specific measures are needed to address multidrug-resistant TB (MDR-TB). Finally, scale-up of all these interventions requires nationally and locally tailored models of care that are patient-centred and provide integrated healthcare delivery for TB, HIV and other comorbidities.
Authors:
Stephen D Lawn; Anthony D Harries; Graeme Meintjes; Haileyesus Getahun; Diane V Havlir; Robin Wood
Publication Detail:
Type:  Editorial; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't; Review    
Journal Detail:
Title:  AIDS (London, England)     Volume:  26     ISSN:  1473-5571     ISO Abbreviation:  AIDS     Publication Date:  2012 Nov 
Date Detail:
Created Date:  2012-11-05     Completed Date:  2013-04-01     Revised Date:  2014-03-19    
Medline Journal Info:
Nlm Unique ID:  8710219     Medline TA:  AIDS     Country:  England    
Other Details:
Languages:  eng     Pagination:  2121-33     Citation Subset:  IM; X    
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MeSH Terms
Descriptor/Qualifier:
AIDS-Related Opportunistic Infections / drug therapy*,  mortality*,  prevention & control
Acquired Immunodeficiency Syndrome / drug therapy,  prevention & control*
Africa South of the Sahara / epidemiology
Anti-HIV Agents / therapeutic use*
Anti-Infective Agents / therapeutic use*
CD4 Lymphocyte Count
Delivery of Health Care
Female
HIV Seropositivity / drug therapy*
Humans
Incidence
Male
Mass Screening
Risk Factors
Trimethoprim-Sulfamethoxazole Combination / therapeutic use*
Tuberculosis / drug therapy*,  mortality*
Tuberculosis, Multidrug-Resistant / drug therapy,  mortality
Grant Support
ID/Acronym/Agency:
1U2RTW007373-01A1//PHS HHS; 5 R01AI058736-02/AI/NIAID NIH HHS; 5U01AI069924-02/AI/NIAID NIH HHS; A151982//PHS HHS; K24 AI051982/AI/NIAID NIH HHS; R01 AI058736/AI/NIAID NIH HHS; U01 AI069924/AI/NIAID NIH HHS; U2R TW007370/TW/FIC NIH HHS; U2R TW007373/TW/FIC NIH HHS; U2RTW007370//PHS HHS; //Wellcome Trust
Chemical
Reg. No./Substance:
0/Anti-HIV Agents; 0/Anti-Infective Agents; 8064-90-2/Trimethoprim-Sulfamethoxazole Combination
Comments/Corrections

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