Prevalent and Incident Tuberculosis Are Independent Risk Factors for Mortality among Patients Accessing Antiretroviral Therapy in South Africa
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{"title"=>"Prevalent and Incident Tuberculosis Are Independent Risk Factors for Mortality among Patients Accessing Antiretroviral Therapy in South Africa", "type"=>"journal", "authors"=>[{"first_name"=>"Ankur", "last_name"=>"Gupta", "scopus_author_id"=>"56898350900"}, {"first_name"=>"Robin", "last_name"=>"Wood", "scopus_author_id"=>"7404053384"}, {"first_name"=>"Richard", "last_name"=>"Kaplan", "scopus_author_id"=>"56959528500"}, {"first_name"=>"Linda Gail", "last_name"=>"Bekker", "scopus_author_id"=>"7003924915"}, {"first_name"=>"Stephen D.", "last_name"=>"Lawn", "scopus_author_id"=>"7006905471"}], "year"=>2013, "source"=>"PLoS ONE", "identifiers"=>{"issn"=>"19326203", "scopus"=>"2-s2.0-84873907656", "sgr"=>"84873907656", "pui"=>"368342624", "isbn"=>"1932-6203", "pmid"=>"23418463", "doi"=>"10.1371/journal.pone.0055824"}, "id"=>"de29027f-24bb-3815-86d6-7fab9b608a75", "abstract"=>"BACKGROUND: Patients with prevalent or incident tuberculosis (TB) in antiretroviral treatment (ART) programmes in sub-Saharan Africa have high mortality risk. However, published data are contradictory as to whether TB is a risk factor for mortality that is independent of CD4 cell counts and other patient characteristics.\\n\\nMETHODS/FINDINGS: This observational ART cohort study was based in Cape Town, South Africa. Deaths from all causes were ascertained among patients receiving ART for up to 8 years. TB diagnoses and 4-monthly CD4 cell counts were recorded. Mortality rates were calculated and Poisson regression models were used to calculate incidence rate ratios (IRR) and identify risk factors for mortality. Of 1544 patients starting ART, 464 patients had prevalent TB at baseline and 424 developed incident TB during a median of 5.0 years follow-up. Most TB diagnoses (73.6%) were culture-confirmed. A total of 208 (13.5%) patients died during ART and mortality rates were 8.84 deaths/100 person-years during the first year of ART and decreased to 1.14 deaths/100 person-years after 5 years. In multivariate analyses adjusted for baseline and time-updated risk factors, both prevalent and incident TB were independent risk factors for mortality (IRR 1.7 [95% CI, 1.2-2.3] and 2.7 [95% CI, 1.9-3.8], respectively). Adjusted mortality risks were higher in the first 6 months of ART for those with prevalent TB at baseline (IRR 2.33; 95% CI, 1.5-3.5) and within the 6 months following diagnoses of incident TB (IRR 3.8; 95% CI, 2.6-5.7).\\n\\nCONCLUSIONS: Prevalent TB at baseline and incident TB during ART were strongly associated with increased mortality risk. This effect was time-dependent, suggesting that TB and mortality are likely to be causally related and that TB is not simply an epiphenomenon among highly immunocompromised patients. Strategies to rapidly diagnose, treat and prevent TB prior to and during ART urgently need to be implemented.", "link"=>"http://www.mendeley.com/research/prevalent-incident-tuberculosis-independent-risk-factors-mortality-among-patients-accessing-antiretr-10", "reader_count"=>36, "reader_count_by_academic_status"=>{"Researcher"=>9, "Student > Ph. D. Student"=>8, "Student > Postgraduate"=>3, "Student > Master"=>14, "Other"=>1, "Lecturer > Senior Lecturer"=>1}, "reader_count_by_user_role"=>{"Researcher"=>9, "Student > Ph. D. Student"=>8, "Student > Postgraduate"=>3, "Student > Master"=>14, "Other"=>1, "Lecturer > Senior Lecturer"=>1}, "reader_count_by_subject_area"=>{"Unspecified"=>3, "Nursing and Health Professions"=>1, "Medicine and Dentistry"=>22, "Agricultural and Biological Sciences"=>4, "Pharmacology, Toxicology and Pharmaceutical Science"=>2, "Computer Science"=>3, "Immunology and Microbiology"=>1}, "reader_count_by_subdiscipline"=>{"Medicine and Dentistry"=>{"Medicine and Dentistry"=>22}, "Immunology and Microbiology"=>{"Immunology and Microbiology"=>1}, "Agricultural and Biological Sciences"=>{"Agricultural and Biological Sciences"=>4}, "Computer Science"=>{"Computer Science"=>3}, "Nursing and Health Professions"=>{"Nursing and Health Professions"=>1}, "Unspecified"=>{"Unspecified"=>3}, "Pharmacology, Toxicology and Pharmaceutical Science"=>{"Pharmacology, Toxicology and Pharmaceutical Science"=>2}}, "reader_count_by_country"=>{"Malawi"=>1, "South Africa"=>4, "Zimbabwe"=>1}, "group_count"=>1}

Scopus | Further Information

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Figshare

  • {"files"=>["https://ndownloader.figshare.com/files/489137"], "description"=>"<p>Mortality incident risk ratios (IRR) associated with person-time accrued following prevalent (⧫) and incident (⋄) tuberculosis (TB) compared to person-time with no TB diagnosis, adjusted for time-updated CD4 cell count and HIV viral load, and other time-updated and baseline risk factors, stratified by timing after TB diagnosis, recurrent TB including all previous TB diagnoses (▴) or multiple diagnoses of incident TB (▵).</p>", "links"=>[], "tags"=>["ratios", "person-time", "accrued", "prevalent", "tuberculosis", "compared", "tb", "adjusted", "time-updated", "cd4", "hiv", "viral", "baseline", "stratified", "recurrent", "diagnoses"], "article_id"=>159632, "categories"=>["Cancer", "Infectious Diseases"], "users"=>["Ankur Gupta", "Robin Wood", "Richard Kaplan", "Linda-Gail Bekker", "Stephen D. Lawn"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0055824.g002", "stats"=>{"downloads"=>1, "page_views"=>10, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Mortality_incident_risk_ratios_IRR_associated_with_person_time_accrued_following_prevalent_10731_and_incident_8900_tuberculosis_TB_compared_to_person_time_with_no_TB_diagnosis_adjusted_for_time_updated_CD4_cell_count_and_HIV_viral_load_and_other_time_upd/159632", "title"=>"Mortality incident risk ratios (IRR) associated with person-time accrued following prevalent (⧫) and incident (⋄) tuberculosis (TB) compared to person-time with no TB diagnosis, adjusted for time-updated CD4 cell count and HIV viral load, and other time-updated and baseline risk factors, stratified by timing after TB diagnosis, recurrent TB including all previous TB diagnoses (▴) or multiple diagnoses of incident TB (▵).", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2013-02-19 15:24:25"}
  • {"files"=>["https://ndownloader.figshare.com/files/489003"], "description"=>"<p>Patient enrolment in the antiretroviral treatment service and outcomes during follow-up.</p>", "links"=>[], "tags"=>["enrolment", "antiretroviral", "outcomes"], "article_id"=>159523, "categories"=>["Cancer", "Infectious Diseases"], "users"=>["Ankur Gupta", "Robin Wood", "Richard Kaplan", "Linda-Gail Bekker", "Stephen D. Lawn"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0055824.g001", "stats"=>{"downloads"=>2, "page_views"=>5, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Patient_enrolment_in_the_antiretroviral_treatment_service_and_outcomes_during_follow_up_/159523", "title"=>"Patient enrolment in the antiretroviral treatment service and outcomes during follow-up.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2013-02-19 15:23:43"}
  • {"files"=>["https://ndownloader.figshare.com/files/489245"], "description"=>"<p>ART, antiretroviral therapy; TB, tuberculosis PY, person-years; CI, confidence intervals.</p>a<p>During person-time accrued following a diagnosis of incident TB.</p>", "links"=>[], "tags"=>["rates", "tb", "cd4"], "article_id"=>159770, "categories"=>["Cancer", "Infectious Diseases"], "users"=>["Ankur Gupta", "Robin Wood", "Richard Kaplan", "Linda-Gail Bekker", "Stephen D. Lawn"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0055824.t002", "stats"=>{"downloads"=>0, "page_views"=>0, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Overall_mortality_rates_and_mortality_rates_following_incident_TB_during_ART_by_CD4_cell_strata_/159770", "title"=>"Overall mortality rates and mortality rates following incident TB during ART by CD4 cell strata.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2013-02-19 15:25:08"}
  • {"files"=>["https://ndownloader.figshare.com/files/489210"], "description"=>"<p>Data are numbers (%) unless otherwise stated. ART, antiretroviral therapy; TB, tuberculosis; IQR, interquartile range.</p>a<p>includes all TB episodes where anti-TB treatment was completed prior to ART enrolment.</p>b<p>TB episodes where patients are taking anti-TB treatment at ART initiation.</p>c<p>alive at data censorship on 1<sup>st</sup> January 2011.</p>d<p>calculated comparing patients that died with those LTFU.</p>", "links"=>[], "tags"=>["patients", "follow-up"], "article_id"=>159738, "categories"=>["Cancer", "Infectious Diseases"], "users"=>["Ankur Gupta", "Robin Wood", "Richard Kaplan", "Linda-Gail Bekker", "Stephen D. Lawn"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0055824.t001", "stats"=>{"downloads"=>0, "page_views"=>1, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Characteristics_for_all_patients_and_those_alive_at_data_censorship_lost_to_follow_up_and_died_/159738", "title"=>"Characteristics for all patients and those alive at data censorship, lost to follow-up and died.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2013-02-19 15:24:58"}
  • {"files"=>["https://ndownloader.figshare.com/files/489278"], "description"=>"<p>ART, antiretroviral therapy; TB, tuberculosis; IRR, incident rate ratio; CI, confidence interval. All p-values were calculated using the likelihood ratio test.</p>a<p>Age is included as continuous variable, the IRR represents a 1 year increase in age.</p>b<p>includes all TB episodes where anti-TB treatment was completed prior to ART enrolment.</p>c<p>TB episodes where patients are taking anti-TB treatment at ART initiation.</p>d<p>CD4 cell counts and viral load are time-updated variables using serial measurements taken during ART.</p>", "links"=>[], "tags"=>["multivariate", "analyses", "factors"], "article_id"=>159803, "categories"=>["Cancer", "Infectious Diseases"], "users"=>["Ankur Gupta", "Robin Wood", "Richard Kaplan", "Linda-Gail Bekker", "Stephen D. Lawn"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0055824.t003", "stats"=>{"downloads"=>1, "page_views"=>4, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Unadjusted_and_multivariate_analyses_of_risk_factors_for_mortality_during_ART_/159803", "title"=>"Unadjusted and multivariate analyses of risk factors for mortality during ART.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2013-02-19 15:25:18"}

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Relative Metric

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