Predictors of early mortality and effectiveness of antiretroviral therapy in TB-HIV patients from Brazil

Detalhes bibliográficos
Autor(a) principal: Demitto, Fernanda de Oliveira
Data de Publicação: 2019
Outros Autores: Schmaltz, Carolina Arana Stanis, Sant’Anna, Flávia M., Arriaga Gutiérrez, María Belen, Andrade, Bruno de Bezerril, Rolla, Valeria Cavalcanti
Tipo de documento: Artigo
Idioma: eng
Título da fonte: Repositório Institucional da FIOCRUZ (ARCA)
Texto Completo: https://www.arca.fiocruz.br/handle/icict/34196
Resumo: Ministry of Heath UNODC (agreement 113/2013) for financial support. We also thank Coordenac¸ão de Aperfeiçoamento de Pessoal de Nível Superior (finance code: 001) for supporting Fernanda Demitto as a post graduate student and the help from Ivan Maia and Betaˆnia Nogueira in collecting information for the dataset. The work from BBA was supported by intramural research program from FIOCRUZ and from the National Institutes of Health (U01AI115940). MBA received a fellowship from the Fundac¸ão de Amparo à Pesquisa da Bahia (FAPESB).
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spelling Demitto, Fernanda de OliveiraSchmaltz, Carolina Arana StanisSant’Anna, Flávia M.Arriaga Gutiérrez, María BelenAndrade, Bruno de BezerrilRolla, Valeria Cavalcanti2019-07-17T17:12:08Z2019-07-17T17:12:08Z2019DEMITTO, Fernanda de Oliveira et al. Predictors of early mortality and effectiveness of antiretroviral therapy in TB-HIV patients from Brazil. Plos One, v. 14, n. 6, p. 1-11, June 2019.1932-6203https://www.arca.fiocruz.br/handle/icict/3419610.1371/journal.pone.0217014Ministry of Heath UNODC (agreement 113/2013) for financial support. We also thank Coordenac¸ão de Aperfeiçoamento de Pessoal de Nível Superior (finance code: 001) for supporting Fernanda Demitto as a post graduate student and the help from Ivan Maia and Betaˆnia Nogueira in collecting information for the dataset. The work from BBA was supported by intramural research program from FIOCRUZ and from the National Institutes of Health (U01AI115940). MBA received a fellowship from the Fundac¸ão de Amparo à Pesquisa da Bahia (FAPESB).Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Pos-Graduação em Pesquisa Clınica em Doenças Infecciosas. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Pesquisa Clínica em Micobacterioses. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Pesquisa Clínica em Micobacterioses. Rio de Janeiro, RJ, Brasil.Multinational Organization Network Sponsoring Translational and Epidemiological Research. Initiative, Salvador, BA, Brazil / Fundação Oswaldo Cruz. Instituto Gonçalo Moniz, Salvador, BA, Brasil.Multinational Organization Network Sponsoring Translational and Epidemiological Research. Initiative, Salvador, BA, Brazil / Fundação Oswaldo Cruz. Instituto Gonçalo Moniz, Salvador, BA, Brasil.Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Pós-Graduação em Pesquisa Clínica em Doenças Infecciosas. Rio de Janeiro, RJ, Brasil / Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Pesquisa Clínica em Micobacterioses. Rio de Janeiro, RJ, Brasil.Background: The implementation of antiretroviral (ARV) therapy caused a significant decrease in HIVassociated mortality worldwide. Nevertheless, mortality is still high among people living with HIV/AIDS and tuberculosis (TB). ARV-naïve HIV patients coinfected with tuberculosis (TB) have more options to treat both diseases concomitantly. Nevertheless, some TB-HIV patients undertaking ARVs (ARV-experienced) are already failing the first line efavirenzbased regimen and seem to display different response to second line ARV therapy and exhibit other predictors of mortality. Methods: We performed a retrospective cohort study including 273 patients diagnosed with TB-HIV and treated at a referral center in Rio de Janeiro, Brazil, between 2008 and 2016. Multivariate analysis and Cox regression models were used to evaluate the effectiveness of ARV therapy regimens (viral load [VL] <80 copies from the 4th to 10th months after TB therapy introduction) and to identify predictors of early mortality (100 days after TB therapy initiation) considering ARV-naïve and ARV-experienced patients adjusting for sociodemographic, clinical and therapeutic covariates. Findings: Survival analysis included 273 patients, out of whom 154 (56.4%) were ARV-naïve and 119 (43.6%) were ARV-experienced. Seven deaths occurred within 6 months of anti-TB treatment, 4 in ARV-naïve and 3 in ARV-experienced patients. Multivariate analysis revealed that in ARV-naïve patients, the chance of death was substantially higher in patients who developed immune reconstitution inflammatory syndrome during the study follow up (HR = 40.6, p<0.01). For ARV-experienced patients, similar analyses failed to identify factors significantly associated with mortality. Variables independently associated with treatment failure for the ARV-naïve group were previous TB (adjusted OR [aOR] = 6.1 p = 0.03) and alcohol abuse (aOR = 3.7 p = 0.01). For ARV-experienced patients, a ritonavir boosted. Protease Inhibitor-based regimen resulted in a 2.6 times higher risk of treatment failure compared to the use of efavirenz based ARV regimens (p = 0.03) and High baseline HIV VL (p = 0.03) were predictors of treatment failure. Conclusions: Risk factors for mortality and ARV failure were different for ARV-naïve and ARV-experienced patients. The latter patient group should be targeted for trials with less toxic and rifampicin-compatible drugs to improve TB-HIV treatment outcomes and prevent death.engPublic Library of ScienceHIVMortalidadeFatores de riscoTratamentoHumanosBrasilHIVMortalityRisk factorsTreatmentHumansBrazilPredictors of early mortality and effectiveness of antiretroviral therapy in TB-HIV patients from Brazilinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articleinfo:eu-repo/semantics/openAccessreponame:Repositório Institucional da FIOCRUZ (ARCA)instname:Fundação Oswaldo Cruz (FIOCRUZ)instacron:FIOCRUZLICENSElicense.txtlicense.txttext/plain; charset=utf-82991https://www.arca.fiocruz.br/bitstream/icict/34196/1/license.txt5a560609d32a3863062d77ff32785d58MD51ORIGINALDemitto, F.O. Predictors of early...2019.pdfDemitto, F.O. 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dc.title.pt_BR.fl_str_mv Predictors of early mortality and effectiveness of antiretroviral therapy in TB-HIV patients from Brazil
title Predictors of early mortality and effectiveness of antiretroviral therapy in TB-HIV patients from Brazil
spellingShingle Predictors of early mortality and effectiveness of antiretroviral therapy in TB-HIV patients from Brazil
Demitto, Fernanda de Oliveira
HIV
Mortalidade
Fatores de risco
Tratamento
Humanos
Brasil
HIV
Mortality
Risk factors
Treatment
Humans
Brazil
title_short Predictors of early mortality and effectiveness of antiretroviral therapy in TB-HIV patients from Brazil
title_full Predictors of early mortality and effectiveness of antiretroviral therapy in TB-HIV patients from Brazil
title_fullStr Predictors of early mortality and effectiveness of antiretroviral therapy in TB-HIV patients from Brazil
title_full_unstemmed Predictors of early mortality and effectiveness of antiretroviral therapy in TB-HIV patients from Brazil
title_sort Predictors of early mortality and effectiveness of antiretroviral therapy in TB-HIV patients from Brazil
author Demitto, Fernanda de Oliveira
author_facet Demitto, Fernanda de Oliveira
Schmaltz, Carolina Arana Stanis
Sant’Anna, Flávia M.
Arriaga Gutiérrez, María Belen
Andrade, Bruno de Bezerril
Rolla, Valeria Cavalcanti
author_role author
author2 Schmaltz, Carolina Arana Stanis
Sant’Anna, Flávia M.
Arriaga Gutiérrez, María Belen
Andrade, Bruno de Bezerril
Rolla, Valeria Cavalcanti
author2_role author
author
author
author
author
dc.contributor.author.fl_str_mv Demitto, Fernanda de Oliveira
Schmaltz, Carolina Arana Stanis
Sant’Anna, Flávia M.
Arriaga Gutiérrez, María Belen
Andrade, Bruno de Bezerril
Rolla, Valeria Cavalcanti
dc.subject.other.pt_BR.fl_str_mv HIV
Mortalidade
Fatores de risco
Tratamento
Humanos
Brasil
topic HIV
Mortalidade
Fatores de risco
Tratamento
Humanos
Brasil
HIV
Mortality
Risk factors
Treatment
Humans
Brazil
dc.subject.en.pt_BR.fl_str_mv HIV
Mortality
Risk factors
Treatment
Humans
Brazil
description Ministry of Heath UNODC (agreement 113/2013) for financial support. We also thank Coordenac¸ão de Aperfeiçoamento de Pessoal de Nível Superior (finance code: 001) for supporting Fernanda Demitto as a post graduate student and the help from Ivan Maia and Betaˆnia Nogueira in collecting information for the dataset. The work from BBA was supported by intramural research program from FIOCRUZ and from the National Institutes of Health (U01AI115940). MBA received a fellowship from the Fundac¸ão de Amparo à Pesquisa da Bahia (FAPESB).
publishDate 2019
dc.date.accessioned.fl_str_mv 2019-07-17T17:12:08Z
dc.date.available.fl_str_mv 2019-07-17T17:12:08Z
dc.date.issued.fl_str_mv 2019
dc.type.status.fl_str_mv info:eu-repo/semantics/publishedVersion
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dc.identifier.citation.fl_str_mv DEMITTO, Fernanda de Oliveira et al. Predictors of early mortality and effectiveness of antiretroviral therapy in TB-HIV patients from Brazil. Plos One, v. 14, n. 6, p. 1-11, June 2019.
dc.identifier.uri.fl_str_mv https://www.arca.fiocruz.br/handle/icict/34196
dc.identifier.issn.pt_BR.fl_str_mv 1932-6203
dc.identifier.doi.pt_BR.fl_str_mv 10.1371/journal.pone.0217014
identifier_str_mv DEMITTO, Fernanda de Oliveira et al. Predictors of early mortality and effectiveness of antiretroviral therapy in TB-HIV patients from Brazil. Plos One, v. 14, n. 6, p. 1-11, June 2019.
1932-6203
10.1371/journal.pone.0217014
url https://www.arca.fiocruz.br/handle/icict/34196
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dc.publisher.none.fl_str_mv Public Library of Science
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