Impact of HIV on mortality among patients treated for tuberculosis in Lima, Peru: a prospective cohort study

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Impact of HIV on mortality among patients treated for tuberculosis in Lima, Peru: a prospective cohort study

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Title: Impact of HIV on mortality among patients treated for tuberculosis in Lima, Peru: a prospective cohort study
Author: Velasquez, Gustavo Eduardo; Cegielski, J. Peter; Murray, Megan Blanche; 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 Sterling; Contreras, Carmen C.; Cruz, Janeth Santa; Shin, Sonya Sunhi

Note: Order does not necessarily reflect citation order of authors.

Citation: Velásquez, G. E., J. P. Cegielski, M. B. Murray, M. J. A. Yagui, L. L. Asencios, J. N. Bayona, C. A. Bonilla, et al. 2015. “Impact of HIV on Mortality Among Patients Treated for Tuberculosis in Lima, Peru: a Prospective Cohort Study.” BMC Infectious Diseases 16 (1) (December). doi:10.1186/s12879-016-1375-8.
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Abstract: 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.
Published Version: doi:10.1186/s12879-016-1375-8
Terms of Use: This article is made available under the terms and conditions applicable to Other Posted Material, as set forth at http://nrs.harvard.edu/urn-3:HUL.InstRepos:dash.current.terms-of-use#LAA
Citable link to this page: http://nrs.harvard.edu/urn-3:HUL.InstRepos:33766506
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