Prognostic significance of the interval between the initiation of antiretroviral therapy and the initiation of anti-tuberculosis treatment in HIV/tuberculosis-coinfected patients

Results from the TREAT Asia HIV Observational Database

S. H. Han, J. Zhou, M. P. Lee, H. Zhao, Y. M.A. Chen, N. Kumarasamy, S. Pujari, C. Lee, S. F.S. Omar, R. Ditangco, N. Phanuphak, S. Kiertiburanakul, R. Chaiwarith, T. P. Merati, E. Yunihastuti, J. Tanuma, V. Saphonn, A. H. Sohn, J. Y. Choi, C. V. Mean & 30 others V. Saphonn, K. Vohith, F. J. Zhang, H. X. Zhao, N. Han, P. C.K. Li, M. P. Lee, N. Kumarasamy, S. Saghayam, C. Ezhilarasi, S. Pujari, K. Joshi, A. Makane, T. P. Merati, D. N. Wirawan, F. Yuliana, E. Yunihastuti, D. Imran, A. Widhani, S. Oka, J. Tanuma, T. Nishijima, J. Y. Choi, S. H. Han, J. M. Kim, C. Lee, B. L.H. Sim, Y. M.A. Chen, L. H. Kuo, L. S. Lee

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Objectives: We evaluated the effect of the time interval between the initiation of antiretroviral therapy (ART) and the initiation of tuberculosis (TB) treatment on clinical outcomes in HIV/TB-coinfected patients in an Asian regional cohort. Methods: Adult HIV/TB-coinfected patients in an observational HIV-infected cohort database who had a known date of ART initiation and a history of TB treatment were eligible for study inclusion. The time interval between the initiation of ART and the initiation of TB treatment was categorized as follows: TB diagnosed while on ART, ART initiated ≤90 days after initiation of TB treatment ('early ART'), ART initiated >90 days after initiation of TB treatment ('delayed ART'), and ART not started. Outcomes were assessed using survival analyses. Results: A total of 768 HIV/TB-coinfected patients were included in this study. The median CD4 T-cell count at TB diagnosis was 100 [interquartile range (IQR) 40-208] cells/μL. Treatment outcomes were not significantly different between the groups with early ART and delayed ART initiation. Kaplan-Meier analysis indicated that mortality was highest for those diagnosed with TB while on ART (3.77 deaths per 100 person-years), and the prognoses of other groups were not different (in deaths per 100 person-years: 2.12 for early ART, 1.46 for delayed ART, and 2.94 for ART not started). In a multivariate model, the interval between ART initiation and TB therapy initiation did not significantly impact all-cause mortality. Conclusions: A negative impact of delayed ART in patients coinfected with TB was not observed in this observational cohort of moderately to severely immunosuppressed patients. The broader impact of earlier ART initiation in actual clinical practice should be monitored more closely.

Original languageEnglish
Pages (from-to)77-85
Number of pages9
JournalHIV Medicine
Volume15
Issue number2
DOIs
Publication statusPublished - Jan 1 2014
Externally publishedYes

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Tuberculosis
HIV
Databases
Therapeutics
Secondary Prevention
Mortality
Kaplan-Meier Estimate
CD4 Lymphocyte Count
Survival Analysis

ASJC Scopus subject areas

  • Health Policy
  • Infectious Diseases
  • Pharmacology (medical)

Cite this

Prognostic significance of the interval between the initiation of antiretroviral therapy and the initiation of anti-tuberculosis treatment in HIV/tuberculosis-coinfected patients : Results from the TREAT Asia HIV Observational Database. / Han, S. H.; Zhou, J.; Lee, M. P.; Zhao, H.; Chen, Y. M.A.; Kumarasamy, N.; Pujari, S.; Lee, C.; Omar, S. F.S.; Ditangco, R.; Phanuphak, N.; Kiertiburanakul, S.; Chaiwarith, R.; Merati, T. P.; Yunihastuti, E.; Tanuma, J.; Saphonn, V.; Sohn, A. H.; Choi, J. Y.; Mean, C. V.; Saphonn, V.; Vohith, K.; Zhang, F. J.; Zhao, H. X.; Han, N.; Li, P. C.K.; Lee, M. P.; Kumarasamy, N.; Saghayam, S.; Ezhilarasi, C.; Pujari, S.; Joshi, K.; Makane, A.; Merati, T. P.; Wirawan, D. N.; Yuliana, F.; Yunihastuti, E.; Imran, D.; Widhani, A.; Oka, S.; Tanuma, J.; Nishijima, T.; Choi, J. Y.; Han, S. H.; Kim, J. M.; Lee, C.; Sim, B. L.H.; Chen, Y. M.A.; Kuo, L. H.; Lee, L. S.

In: HIV Medicine, Vol. 15, No. 2, 01.01.2014, p. 77-85.

Research output: Contribution to journalArticle

Han, SH, Zhou, J, Lee, MP, Zhao, H, Chen, YMA, Kumarasamy, N, Pujari, S, Lee, C, Omar, SFS, Ditangco, R, Phanuphak, N, Kiertiburanakul, S, Chaiwarith, R, Merati, TP, Yunihastuti, E, Tanuma, J, Saphonn, V, Sohn, AH, Choi, JY, Mean, CV, Saphonn, V, Vohith, K, Zhang, FJ, Zhao, HX, Han, N, Li, PCK, Lee, MP, Kumarasamy, N, Saghayam, S, Ezhilarasi, C, Pujari, S, Joshi, K, Makane, A, Merati, TP, Wirawan, DN, Yuliana, F, Yunihastuti, E, Imran, D, Widhani, A, Oka, S, Tanuma, J, Nishijima, T, Choi, JY, Han, SH, Kim, JM, Lee, C, Sim, BLH, Chen, YMA, Kuo, LH & Lee, LS 2014, 'Prognostic significance of the interval between the initiation of antiretroviral therapy and the initiation of anti-tuberculosis treatment in HIV/tuberculosis-coinfected patients: Results from the TREAT Asia HIV Observational Database', HIV Medicine, vol. 15, no. 2, pp. 77-85. https://doi.org/10.1111/hiv.12073
Han, S. H. ; Zhou, J. ; Lee, M. P. ; Zhao, H. ; Chen, Y. M.A. ; Kumarasamy, N. ; Pujari, S. ; Lee, C. ; Omar, S. F.S. ; Ditangco, R. ; Phanuphak, N. ; Kiertiburanakul, S. ; Chaiwarith, R. ; Merati, T. P. ; Yunihastuti, E. ; Tanuma, J. ; Saphonn, V. ; Sohn, A. H. ; Choi, J. Y. ; Mean, C. V. ; Saphonn, V. ; Vohith, K. ; Zhang, F. J. ; Zhao, H. X. ; Han, N. ; Li, P. C.K. ; Lee, M. P. ; Kumarasamy, N. ; Saghayam, S. ; Ezhilarasi, C. ; Pujari, S. ; Joshi, K. ; Makane, A. ; Merati, T. P. ; Wirawan, D. N. ; Yuliana, F. ; Yunihastuti, E. ; Imran, D. ; Widhani, A. ; Oka, S. ; Tanuma, J. ; Nishijima, T. ; Choi, J. Y. ; Han, S. H. ; Kim, J. M. ; Lee, C. ; Sim, B. L.H. ; Chen, Y. M.A. ; Kuo, L. H. ; Lee, L. S. / Prognostic significance of the interval between the initiation of antiretroviral therapy and the initiation of anti-tuberculosis treatment in HIV/tuberculosis-coinfected patients : Results from the TREAT Asia HIV Observational Database. In: HIV Medicine. 2014 ; Vol. 15, No. 2. pp. 77-85.
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abstract = "Objectives: We evaluated the effect of the time interval between the initiation of antiretroviral therapy (ART) and the initiation of tuberculosis (TB) treatment on clinical outcomes in HIV/TB-coinfected patients in an Asian regional cohort. Methods: Adult HIV/TB-coinfected patients in an observational HIV-infected cohort database who had a known date of ART initiation and a history of TB treatment were eligible for study inclusion. The time interval between the initiation of ART and the initiation of TB treatment was categorized as follows: TB diagnosed while on ART, ART initiated ≤90 days after initiation of TB treatment ('early ART'), ART initiated >90 days after initiation of TB treatment ('delayed ART'), and ART not started. Outcomes were assessed using survival analyses. Results: A total of 768 HIV/TB-coinfected patients were included in this study. The median CD4 T-cell count at TB diagnosis was 100 [interquartile range (IQR) 40-208] cells/μL. Treatment outcomes were not significantly different between the groups with early ART and delayed ART initiation. Kaplan-Meier analysis indicated that mortality was highest for those diagnosed with TB while on ART (3.77 deaths per 100 person-years), and the prognoses of other groups were not different (in deaths per 100 person-years: 2.12 for early ART, 1.46 for delayed ART, and 2.94 for ART not started). In a multivariate model, the interval between ART initiation and TB therapy initiation did not significantly impact all-cause mortality. Conclusions: A negative impact of delayed ART in patients coinfected with TB was not observed in this observational cohort of moderately to severely immunosuppressed patients. The broader impact of earlier ART initiation in actual clinical practice should be monitored more closely.",
author = "Han, {S. H.} and J. Zhou and Lee, {M. P.} and H. Zhao and Chen, {Y. M.A.} and N. Kumarasamy and S. Pujari and C. Lee and Omar, {S. F.S.} and R. Ditangco and N. Phanuphak and S. Kiertiburanakul and R. Chaiwarith and Merati, {T. P.} and E. Yunihastuti and J. Tanuma and V. Saphonn and Sohn, {A. H.} and Choi, {J. Y.} and Mean, {C. V.} and V. Saphonn and K. Vohith and Zhang, {F. J.} and Zhao, {H. X.} and N. Han and Li, {P. C.K.} and Lee, {M. P.} and N. Kumarasamy and S. Saghayam and C. Ezhilarasi and S. Pujari and K. Joshi and A. Makane and Merati, {T. P.} and Wirawan, {D. N.} and F. Yuliana and E. Yunihastuti and D. Imran and A. Widhani and S. Oka and J. Tanuma and T. Nishijima and Choi, {J. Y.} and Han, {S. H.} and Kim, {J. M.} and C. Lee and Sim, {B. L.H.} and Chen, {Y. M.A.} and Kuo, {L. H.} and Lee, {L. S.}",
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TY - JOUR

T1 - Prognostic significance of the interval between the initiation of antiretroviral therapy and the initiation of anti-tuberculosis treatment in HIV/tuberculosis-coinfected patients

T2 - Results from the TREAT Asia HIV Observational Database

AU - Han, S. H.

AU - Zhou, J.

AU - Lee, M. P.

AU - Zhao, H.

AU - Chen, Y. M.A.

AU - Kumarasamy, N.

AU - Pujari, S.

AU - Lee, C.

AU - Omar, S. F.S.

AU - Ditangco, R.

AU - Phanuphak, N.

AU - Kiertiburanakul, S.

AU - Chaiwarith, R.

AU - Merati, T. P.

AU - Yunihastuti, E.

AU - Tanuma, J.

AU - Saphonn, V.

AU - Sohn, A. H.

AU - Choi, J. Y.

AU - Mean, C. V.

AU - Saphonn, V.

AU - Vohith, K.

AU - Zhang, F. J.

AU - Zhao, H. X.

AU - Han, N.

AU - Li, P. C.K.

AU - Lee, M. P.

AU - Kumarasamy, N.

AU - Saghayam, S.

AU - Ezhilarasi, C.

AU - Pujari, S.

AU - Joshi, K.

AU - Makane, A.

AU - Merati, T. P.

AU - Wirawan, D. N.

AU - Yuliana, F.

AU - Yunihastuti, E.

AU - Imran, D.

AU - Widhani, A.

AU - Oka, S.

AU - Tanuma, J.

AU - Nishijima, T.

AU - Choi, J. Y.

AU - Han, S. H.

AU - Kim, J. M.

AU - Lee, C.

AU - Sim, B. L.H.

AU - Chen, Y. M.A.

AU - Kuo, L. H.

AU - Lee, L. S.

PY - 2014/1/1

Y1 - 2014/1/1

N2 - Objectives: We evaluated the effect of the time interval between the initiation of antiretroviral therapy (ART) and the initiation of tuberculosis (TB) treatment on clinical outcomes in HIV/TB-coinfected patients in an Asian regional cohort. Methods: Adult HIV/TB-coinfected patients in an observational HIV-infected cohort database who had a known date of ART initiation and a history of TB treatment were eligible for study inclusion. The time interval between the initiation of ART and the initiation of TB treatment was categorized as follows: TB diagnosed while on ART, ART initiated ≤90 days after initiation of TB treatment ('early ART'), ART initiated >90 days after initiation of TB treatment ('delayed ART'), and ART not started. Outcomes were assessed using survival analyses. Results: A total of 768 HIV/TB-coinfected patients were included in this study. The median CD4 T-cell count at TB diagnosis was 100 [interquartile range (IQR) 40-208] cells/μL. Treatment outcomes were not significantly different between the groups with early ART and delayed ART initiation. Kaplan-Meier analysis indicated that mortality was highest for those diagnosed with TB while on ART (3.77 deaths per 100 person-years), and the prognoses of other groups were not different (in deaths per 100 person-years: 2.12 for early ART, 1.46 for delayed ART, and 2.94 for ART not started). In a multivariate model, the interval between ART initiation and TB therapy initiation did not significantly impact all-cause mortality. Conclusions: A negative impact of delayed ART in patients coinfected with TB was not observed in this observational cohort of moderately to severely immunosuppressed patients. The broader impact of earlier ART initiation in actual clinical practice should be monitored more closely.

AB - Objectives: We evaluated the effect of the time interval between the initiation of antiretroviral therapy (ART) and the initiation of tuberculosis (TB) treatment on clinical outcomes in HIV/TB-coinfected patients in an Asian regional cohort. Methods: Adult HIV/TB-coinfected patients in an observational HIV-infected cohort database who had a known date of ART initiation and a history of TB treatment were eligible for study inclusion. The time interval between the initiation of ART and the initiation of TB treatment was categorized as follows: TB diagnosed while on ART, ART initiated ≤90 days after initiation of TB treatment ('early ART'), ART initiated >90 days after initiation of TB treatment ('delayed ART'), and ART not started. Outcomes were assessed using survival analyses. Results: A total of 768 HIV/TB-coinfected patients were included in this study. The median CD4 T-cell count at TB diagnosis was 100 [interquartile range (IQR) 40-208] cells/μL. Treatment outcomes were not significantly different between the groups with early ART and delayed ART initiation. Kaplan-Meier analysis indicated that mortality was highest for those diagnosed with TB while on ART (3.77 deaths per 100 person-years), and the prognoses of other groups were not different (in deaths per 100 person-years: 2.12 for early ART, 1.46 for delayed ART, and 2.94 for ART not started). In a multivariate model, the interval between ART initiation and TB therapy initiation did not significantly impact all-cause mortality. Conclusions: A negative impact of delayed ART in patients coinfected with TB was not observed in this observational cohort of moderately to severely immunosuppressed patients. The broader impact of earlier ART initiation in actual clinical practice should be monitored more closely.

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U2 - 10.1111/hiv.12073

DO - 10.1111/hiv.12073

M3 - Article

VL - 15

SP - 77

EP - 85

JO - HIV Medicine

JF - HIV Medicine

SN - 1464-2662

IS - 2

ER -