Factors impacting early mortality in tuberculosis/HIV patients: differences between subjects naïve to and previously started on HAART

Detalhes bibliográficos
Autor(a) principal: Schmaltz, Carolina Arana Stanis
Data de Publicação: 2012
Outros Autores: Santoro-Lopes, Guilherme, Lourenço, Maria Cristina, Morgado, Mariza Gonçalves, Velasque, Luciane de Souza de, Rolla, Valéria Cavalcanti
Tipo de documento: Artigo
Idioma: eng
Título da fonte: Repositório Institucional da FIOCRUZ (ARCA)
Texto Completo: https://www.arca.fiocruz.br/handle/icict/36706
Resumo: Fundação Oswaldo Cruz. Instituto de Pesquisa Clínica Evandro Chagas. Laboratório de Pesquisa Clínica em Micobacterioses. Rio de Janeiro, RJ, Brasil.
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spelling Schmaltz, Carolina Arana StanisSantoro-Lopes, GuilhermeLourenço, Maria CristinaMorgado, Mariza GonçalvesVelasque, Luciane de Souza deRolla, Valéria Cavalcanti2019-10-25T12:23:24Z2019-10-25T12:23:24Z2012SCHMALTZ, Carolina Arana Stanis et al. Factors impacting early mortality in tuberculosis/HIV patients: differences between subjects naïve to and previously started on HAART. Plos One, v. 7, n. 9, p. 1-7, Sept. 2012.1932-6203https://www.arca.fiocruz.br/handle/icict/3670610.1371/journal.pone.0045704engPublic Library of ScienceFactors impacting early mortality in tuberculosis/HIV patients: differences between subjects naïve to and previously started on HAARTinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articleFundação Oswaldo Cruz. Instituto de Pesquisa Clínica Evandro Chagas. Laboratório de Pesquisa Clínica em Micobacterioses. Rio de Janeiro, RJ, Brasil.Universidade Federal do Rio de Janeiro. Hospital Universitário Clementino Fraga Filho. Infectious Diseases Clinic. Rio de Janeiro, RJ, Brazil / Universidade Federal do Rio de Janeiro. Department of Preventive Medicine. Rio de Janeiro, RJ, Brazil.Fundação Oswaldo Cruz. Instituto de Pesquisa Clínica Evandro Chagas. Laboratório de Bacteriologia e Bioensaios. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Instituto de Pesquisa Clínica Evandro Chagas. Laboratório de Bacteriologia e Bioensaios. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Instituto de Pesquisa Clínica Evandro Chagas. Immunology Laboratory. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Instituto de Pesquisa Clínica Evandro Chagas. Laboratório de Pesquisa Clínica em Micobacterioses. Rio de Janeiro, RJ, Brasil / Universidade Federal do Estado do Rio de Janeiro. Department of Mathmatics and Statistics. Rio de Janeiro, RJ, Brazil.Fundação Oswaldo Cruz. Instituto de Pesquisa Clínica Evandro Chagas. Laboratório de Pesquisa Clínica em Micobacterioses. Rio de Janeiro, RJ, Brasil.Background: Mortality among patients with tuberculosis (TB)/HIV is highest during the first few months of antituberculous therapy. The objective of this study was to assess the factors associated with early mortality among TB/HIV patients and whether these factors are similar for HAART naı¨ve and those with prior HAART initiation. Methods: Prospective cohort study including HIV patients with tuberculosis confirmed by culture, cared for at a referral center in Rio de Janeiro, Brazil. Multivariable Cox analysis was used to assess predictors of mortality within 3 months of antituberculous therapy. Results: Among 227 patients included, 90 (40%) started HAART before TB diagnosis. The median time to TB diagnosis after ARV initiation was 5.9 months (interquartile range [IQR] 3.0–8.9 months). Fourteen patients (6%) died within the first 3 months. Mortality was not different between patients previously started on HAART and those who were naïve to it. In the overall adjusted analysis, HAART use during TB treatment (hazard ratio [HR] = 0.21, 95% confidential interval [CI] = 0.06–0.72) and CD4 lymphocyte count .100 cells/mm3 (HR = 0.21, 95% CI = 0.04–0.99) were associated with lower mortality, while subjects with unknown baseline CD4 lymphocyte count (HR = 9.39, 95% CI = 2.56–34.5) had higher mortality. In subgroup analysis, among HAART naı¨ve subjects, disseminated TB (HR = 5.32, 95% CI = 1.09–25.8) and unknown baseline CD4 lymphocyte count (HR = 13.2, 95% CI = 2.71–64.5) were associated with significantly higher mortality, while HAART (HR = 0.14, 95% CI = 0.03–0.69) predicted a better outcome. Among subjects previously started on HAART, mortality was significantly associated with duration of TB symptoms .120 days (HR = 6.15, 95% CI = 1.15–32.9). Conclusions: Predictors of early mortality among TB/HIV patients may vary according to the timing of HAART initiation. Among HAART naïve patients, mortality was influenced by baseline clinical severity, HAART use and, possibly, the quality of care preceding TB diagnosis. For patients with prior HAART initiation, longer delays in TB diagnosis predicted a significantly higher mortality.TuberculosisHIV patientsMortalityHAARTinfo:eu-repo/semantics/openAccessreponame:Repositório Institucional da FIOCRUZ (ARCA)instname:Fundação Oswaldo Cruz (FIOCRUZ)instacron:FIOCRUZLICENSElicense.txttext/plain1748https://www.arca.fiocruz.br/bitstream/icict/36706/1/license.txt8a4605be74aa9ea9d79846c1fba20a33MD51ORIGINALve_Schmaltz_Carolina_etal_INI_2012.pdfve_Schmaltz_Carolina_etal_INI_2012.pdfapplication/pdf241455https://www.arca.fiocruz.br/bitstream/icict/36706/2/ve_Schmaltz_Carolina_etal_INI_2012.pdff6f1c08157c28f8582d5fa7407197533MD52TEXTve_Schmaltz_Carolina_etal_INI_2012.pdf.txtve_Schmaltz_Carolina_etal_INI_2012.pdf.txtExtracted texttext/plain38698https://www.arca.fiocruz.br/bitstream/icict/36706/3/ve_Schmaltz_Carolina_etal_INI_2012.pdf.txt3149bc07f49e8f30ba2b928131c726bdMD53icict/367062019-10-26 02:00:38.691oai:www.arca.fiocruz.br:icict/36706Tk9URTogUExBQ0UgWU9VUiBPV04gTElDRU5TRSBIRVJFClRoaXMgc2FtcGxlIGxpY2Vuc2UgaXMgcHJvdmlkZWQgZm9yIGluZm9ybWF0aW9uYWwgcHVycG9zZXMgb25seS4KCk5PTi1FWENMVVNJVkUgRElTVFJJQlVUSU9OIExJQ0VOU0UKCkJ5IHNpZ25pbmcgYW5kIHN1Ym1pdHRpbmcgdGhpcyBsaWNlbnNlLCB5b3UgKHRoZSBhdXRob3Iocykgb3IgY29weXJpZ2h0Cm93bmVyKSBncmFudHMgdG8gRFNwYWNlIFVuaXZlcnNpdHkgKERTVSkgdGhlIG5vbi1leGNsdXNpdmUgcmlnaHQgdG8gcmVwcm9kdWNlLAp0cmFuc2xhdGUgKGFzIGRlZmluZWQgYmVsb3cpLCBhbmQvb3IgZGlzdHJpYnV0ZSB5b3VyIHN1Ym1pc3Npb24gKGluY2x1ZGluZwp0aGUgYWJzdHJhY3QpIHdvcmxkd2lkZSBpbiBwcmludCBhbmQgZWxlY3Ryb25pYyBmb3JtYXQgYW5kIGluIGFueSBtZWRpdW0sCmluY2x1ZGluZyBidXQgbm90IGxpbWl0ZWQgdG8gYXVkaW8gb3IgdmlkZW8uCgpZb3UgYWdyZWUgdGhhdCBEU1UgbWF5LCB3aXRob3V0IGNoYW5naW5nIHRoZSBjb250ZW50LCB0cmFuc2xhdGUgdGhlCnN1Ym1pc3Npb24gdG8gYW55IG1lZGl1bSBvciBmb3JtYXQgZm9yIHRoZSBwdXJwb3NlIG9mIHByZXNlcnZhdGlvbi4KCllvdSBhbHNvIGFncmVlIHRoYXQgRFNVIG1heSBrZWVwIG1vcmUgdGhhbiBvbmUgY29weSBvZiB0aGlzIHN1Ym1pc3Npb24gZm9yCnB1cnBvc2VzIG9mIHNlY3VyaXR5LCBiYWNrLXVwIGFuZCBwcmVzZXJ2YXRpb24uCgpZb3UgcmVwcmVzZW50IHRoYXQgdGhlIHN1Ym1pc3Npb24gaXMgeW91ciBvcmlnaW5hbCB3b3JrLCBhbmQgdGhhdCB5b3UgaGF2ZQp0aGUgcmlnaHQgdG8gZ3JhbnQgdGhlIHJpZ2h0cyBjb250YWluZWQgaW4gdGhpcyBsaWNlbnNlLiBZb3UgYWxzbyByZXByZXNlbnQKdGhhdCB5b3VyIHN1Ym1pc3Npb24gZG9lcyBub3QsIHRvIHRoZSBiZXN0IG9mIHlvdXIga25vd2xlZGdlLCBpbmZyaW5nZSB1cG9uCmFueW9uZSdzIGNvcHlyaWdodC4KCklmIHRoZSBzdWJtaXNzaW9uIGNvbnRhaW5zIG1hdGVyaWFsIGZvciB3aGljaCB5b3UgZG8gbm90IGhvbGQgY29weXJpZ2h0LAp5b3UgcmVwcmVzZW50IHRoYXQgeW91IGhhdmUgb2J0YWluZWQgdGhlIHVucmVzdHJpY3RlZCBwZXJtaXNzaW9uIG9mIHRoZQpjb3B5cmlnaHQgb3duZXIgdG8gZ3JhbnQgRFNVIHRoZSByaWdodHMgcmVxdWlyZWQgYnkgdGhpcyBsaWNlbnNlLCBhbmQgdGhhdApzdWNoIHRoaXJkLXBhcnR5IG93bmVkIG1hdGVyaWFsIGlzIGNsZWFybHkgaWRlbnRpZmllZCBhbmQgYWNrbm93bGVkZ2VkCndpdGhpbiB0aGUgdGV4dCBvciBjb250ZW50IG9mIHRoZSBzdWJtaXNzaW9uLgoKSUYgVEhFIFNVQk1JU1NJT04gSVMgQkFTRUQgVVBPTiBXT1JLIFRIQVQgSEFTIEJFRU4gU1BPTlNPUkVEIE9SIFNVUFBPUlRFRApCWSBBTiBBR0VOQ1kgT1IgT1JHQU5JWkFUSU9OIE9USEVSIFRIQU4gRFNVLCBZT1UgUkVQUkVTRU5UIFRIQVQgWU9VIEhBVkUKRlVMRklMTEVEIEFOWSBSSUdIVCBPRiBSRVZJRVcgT1IgT1RIRVIgT0JMSUdBVElPTlMgUkVRVUlSRUQgQlkgU1VDSApDT05UUkFDVCBPUiBBR1JFRU1FTlQuCgpEU1Ugd2lsbCBjbGVhcmx5IGlkZW50aWZ5IHlvdXIgbmFtZShzKSBhcyB0aGUgYXV0aG9yKHMpIG9yIG93bmVyKHMpIG9mIHRoZQpzdWJtaXNzaW9uLCBhbmQgd2lsbCBub3QgbWFrZSBhbnkgYWx0ZXJhdGlvbiwgb3RoZXIgdGhhbiBhcyBhbGxvd2VkIGJ5IHRoaXMKbGljZW5zZSwgdG8geW91ciBzdWJtaXNzaW9uLgo=Repositório InstitucionalPUBhttps://www.arca.fiocruz.br/oai/requestrepositorio.arca@fiocruz.bropendoar:21352019-10-26T05:00:38Repositório Institucional da FIOCRUZ (ARCA) - Fundação Oswaldo Cruz (FIOCRUZ)false
dc.title.pt_BR.fl_str_mv Factors impacting early mortality in tuberculosis/HIV patients: differences between subjects naïve to and previously started on HAART
title Factors impacting early mortality in tuberculosis/HIV patients: differences between subjects naïve to and previously started on HAART
spellingShingle Factors impacting early mortality in tuberculosis/HIV patients: differences between subjects naïve to and previously started on HAART
Schmaltz, Carolina Arana Stanis
Tuberculosis
HIV patients
Mortality
HAART
title_short Factors impacting early mortality in tuberculosis/HIV patients: differences between subjects naïve to and previously started on HAART
title_full Factors impacting early mortality in tuberculosis/HIV patients: differences between subjects naïve to and previously started on HAART
title_fullStr Factors impacting early mortality in tuberculosis/HIV patients: differences between subjects naïve to and previously started on HAART
title_full_unstemmed Factors impacting early mortality in tuberculosis/HIV patients: differences between subjects naïve to and previously started on HAART
title_sort Factors impacting early mortality in tuberculosis/HIV patients: differences between subjects naïve to and previously started on HAART
author Schmaltz, Carolina Arana Stanis
author_facet Schmaltz, Carolina Arana Stanis
Santoro-Lopes, Guilherme
Lourenço, Maria Cristina
Morgado, Mariza Gonçalves
Velasque, Luciane de Souza de
Rolla, Valéria Cavalcanti
author_role author
author2 Santoro-Lopes, Guilherme
Lourenço, Maria Cristina
Morgado, Mariza Gonçalves
Velasque, Luciane de Souza de
Rolla, Valéria Cavalcanti
author2_role author
author
author
author
author
dc.contributor.author.fl_str_mv Schmaltz, Carolina Arana Stanis
Santoro-Lopes, Guilherme
Lourenço, Maria Cristina
Morgado, Mariza Gonçalves
Velasque, Luciane de Souza de
Rolla, Valéria Cavalcanti
dc.subject.en.pt_BR.fl_str_mv Tuberculosis
HIV patients
Mortality
HAART
topic Tuberculosis
HIV patients
Mortality
HAART
description Fundação Oswaldo Cruz. Instituto de Pesquisa Clínica Evandro Chagas. Laboratório de Pesquisa Clínica em Micobacterioses. Rio de Janeiro, RJ, Brasil.
publishDate 2012
dc.date.issued.fl_str_mv 2012
dc.date.accessioned.fl_str_mv 2019-10-25T12:23:24Z
dc.date.available.fl_str_mv 2019-10-25T12:23:24Z
dc.type.status.fl_str_mv info:eu-repo/semantics/publishedVersion
dc.type.driver.fl_str_mv info:eu-repo/semantics/article
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status_str publishedVersion
dc.identifier.citation.fl_str_mv SCHMALTZ, Carolina Arana Stanis et al. Factors impacting early mortality in tuberculosis/HIV patients: differences between subjects naïve to and previously started on HAART. Plos One, v. 7, n. 9, p. 1-7, Sept. 2012.
dc.identifier.uri.fl_str_mv https://www.arca.fiocruz.br/handle/icict/36706
dc.identifier.issn.pt_BR.fl_str_mv 1932-6203
dc.identifier.doi.none.fl_str_mv 10.1371/journal.pone.0045704
identifier_str_mv SCHMALTZ, Carolina Arana Stanis et al. Factors impacting early mortality in tuberculosis/HIV patients: differences between subjects naïve to and previously started on HAART. Plos One, v. 7, n. 9, p. 1-7, Sept. 2012.
1932-6203
10.1371/journal.pone.0045704
url https://www.arca.fiocruz.br/handle/icict/36706
dc.language.iso.fl_str_mv eng
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dc.publisher.none.fl_str_mv Public Library of Science
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