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Tuberculosis after One Year of Combination Antiretroviral Therapy in Nigeria.
MedLine Citation:
PMID:  23316724     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
Objective: To determine tuberculosis (TB) incidence and evaluate TB risk in adults after one or more years of use of the impact of combination antiretroviral therapy (cART) one-year response on TB risk. Design: Retrospective cohort study in Jos, Nigeria. Methods: We studied a cohort of HIV-infected adults treated with cART for at least one year. Based on immunologic and virologic responses to cART, patients were categorized into four groups: CD4-Tcell count ≥ 350 cells / mm3 and HIV-1 RNA level ≤ 400 copies/ml (Group 1); CD4-Tcell count ≥ 350 cells /mm3 and HIV-1 RNA level > 400 copies/ml (Group 2); CD4-Tcell counts < 350 cells/ mm3 and HIV-1 RNA level≤400 copies/ml (Group 3) and CD4T-cell counts < 350 cells/mm3 and HIV-1 RNA level >400 copies/ml (Group 4). Time to incident TB for the four groups was analyzed using the Kaplan-Meier method. Cox regression models were used to evaluate predictors of incident TB. Results: In this cohort of 5,093 HIV infected adults, of which 68.4% were female, with mean age 35.1 years (standard deviation 9.1 years), we observed 98 cases of incident TB during four years and three months of follow-up. Overall TB incidence rate was 8.7 cases / 1000 PYFU. Adjusted hazards for incident TB were 2.11 (95% CI 0.97-4.61), 2.05 (95% CI 1.10-3.79) and 3.65(95% CI 1.15-5.06) in group 2, 3 and 4 patients respectively, compared to group 1. Conclusion: Tuberculosis incidence in patients on cART is driven by poor immunologic and/ or virologic response. Optimization of HIV treatment should be prioritized to reduce the burden of TB in this high risk population.
Authors:
Maxwell Oluwole Akanbi; Chad Achenbach; Joseph Feinglass; B Taiwo; Onu Adamu; Pho Mai; Oche Agbaji; Phyllis Jean Kanki; Robert Murphy
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2013-1-15
Journal Detail:
Title:  AIDS research and human retroviruses     Volume:  -     ISSN:  1931-8405     ISO Abbreviation:  AIDS Res. Hum. Retroviruses     Publication Date:  2013 Jan 
Date Detail:
Created Date:  2013-1-15     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8709376     Medline TA:  AIDS Res Hum Retroviruses     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
University of Jos, Internal Medicine, Jos, Nigeria, , Jos University Teaching Hospital, Internal Medicine, Laminga, Jos, Plateau, Nigeria, 930001, +234 8033466771, , APIN Center, Jos University Teaching Hospital, Jos, Nigeria; maxwell_akanbi@yahoo.com.
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