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Bonilla, Cesar

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Bonilla

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Cesar

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Bonilla, Cesar
Author's Publications: search.filters.isAuthorOfPublication.f040adfe-3767-48f9-b4f9-708954d4fa16

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    Impact of HIV on mortality among patients treated for tuberculosis in Lima, Peru: a prospective cohort study
    (Springer Science + Business Media, 2015) Velasquez, Gustavo; Cegielski, J. Peter; Murray, Megan; Yagui, Martin J. A.; Asencios, Luis L.; Bayona, Jaime; Bonilla, Cesar; Jave, Hector O.; Yale, Gloria; Suárez, Carmen Z.; Sanchez, Eduardo; Rojas, Christian; Atwood, Sidney; Contreras, Carmen C.; Cruz, Janeth Santa; Shin, Sonya
    Background: Human immunodeficiency virus (HIV)-associated tuberculosis deaths have decreased worldwide over the past decade. We sought to evaluate the effect of HIV status on tuberculosis mortality among patients undergoing treatment for tuberculosis in Lima, Peru, a low HIV prevalence setting. Methods: We conducted a prospective cohort study of patients treated for tuberculosis between 2005 and 2008 in two adjacent health regions in Lima, Peru (Lima Ciudad and Lima Este). We constructed a multivariate Cox proportional hazards model to evaluate the effect of HIV status on mortality during tuberculosis treatment. Results: Of 1701 participants treated for tuberculosis, 136 (8.0 %) died during tuberculosis treatment. HIV-positive patients constituted 11.0 % of the cohort and contributed to 34.6 % of all deaths. HIV-positive patients were significantly more likely to die (25.1 vs. 5.9 %, P < 0.001) and less likely to be cured (28.3 vs. 39.4 %, P = 0.003). On multivariate analysis, positive HIV status (hazard ratio [HR] = 6.06; 95 % confidence interval [CI], 3.96–9.27), unemployment (HR = 2.24; 95 % CI, 1.55–3.25), and sputum acid-fast bacilli smear positivity (HR = 1.91; 95 % CI, 1.10–3.31) were significantly associated with a higher hazard of death. Conclusions: We demonstrate that positive HIV status was a strong predictor of mortality among patients treated for tuberculosis in the early years after Peru started providing free antiretroviral therapy. As HIV diagnosis and antiretroviral therapy provision are more widely implemented for tuberculosis patients in Peru, future operational research should document the changing profile of HIV-associated tuberculosis mortality.
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    Aggressive Regimens for Multidrug-Resistant Tuberculosis Decrease All-Cause Mortality
    (Public Library of Science, 2013) Mitnick, Carole; Franke, Molly; Rich, Michael; Alcantara Viru, Felix A.; Appleton, Sasha C.; Atwood, Sidney S.; Bayona, Jaime; Bonilla, Cesar; Chalco, Katiuska; Fraser, Hamish S. F.; Furin, Jennifer; Guerra, Dalia; Hurtado, Rocio; Joseph, Keith; Llaro, Karim; Mestanza, Lorena; Mukherjee, Joia; Muñoz, Maribel; Palacios, Eda; Sanchez, Epifanio; Seung, Kwonjune; Shin, Sonya; Sloutsky, Alexander; Tolman, Arielle W.; Becerra, Mercedes
    Rationale: A better understanding of the composition of optimal treatment regimens for multidrug-resistant tuberculosis (MDR-TB) is essential for expanding universal access to effective treatment and for developing new therapies for MDR-TB. Analysis of observational data may inform the definition of an optimized regimen. Objectives: This study assessed the impact of an aggressive regimen–one containing at least five likely effective drugs, including a fluoroquinolone and injectable–on treatment outcomes in a large MDR-TB patient cohort. Methods: This was a retrospective cohort study of patients treated in a national outpatient program in Peru between 1999 and 2002. We examined the association between receiving an aggressive regimen and the rate of death. Measurements and Main Results: In total, 669 patients were treated with individualized regimens for laboratory-confirmed MDR-TB. Isolates were resistant to a mean of 5.4 (SD 1.7) drugs. Cure or completion was achieved in 66.1% (442) of patients; death occurred in 20.8% (139). Patients who received an aggressive regimen were less likely to die (crude hazard ratio [HR]: 0.62; 95% CI: 0.44,0.89), compared to those who did not receive such a regimen. This association held in analyses adjusted for comorbidities and indicators of severity (adjusted HR: 0.63; 95% CI: 0.43,0.93). Conclusions: The aggressive regimen is a robust predictor of MDR-TB treatment outcome. TB policy makers and program directors should consider this standard as they design and implement regimens for patients with drug-resistant disease. Furthermore, the aggressive regimen should be considered the standard background regimen when designing randomized trials of treatment for drug-resistant TB.