Low uptake of antiretroviral therapy after admission with human immunodeficiency virus and tuberculosis in KwaZulu-Natal, South Africa

Richard A. Murphy, H. Sunpath, B. Taha, S. Kappagoda, K. T M Maphasa, D. R. Kuritzkes, L. Smeaton

Research output: Contribution to journalArticle

16 Citations (Scopus)

Abstract

OBJECTIVES: A prospective cohort study was conducted among human immunodeficiency virus (HIV) infected inpatients with tuberculosis (TB) or other opportunistic infections (OIs) in South Africa to estimate subsequent antiretroviral therapy (ART) uptake and survival. METHODS: Logistic regression modeling explored associations between baseline characteristics and starting ART, and ART exposure-adjusted incidence of death was estimated over 6 months of follow-up. RESULTS: Among 49 participants enrolled, median CD4 cell count at hospital discharge was 42 cells/μl and the most common presenting OIs were TB (76%), Pneumocystis pneumonia (8%), chronic diarrhea (8%), cryptococcal meningitis (6%), and Toxoplasma gondii (4%). By 6 months, only 20 (45%) patients had initiated ART, and four (8%) were lost to follow-up. ART uptake was independently associated with previous use of traditional medicine (OR 7.2, 95%CI 1.4-55.1) and with less advanced HIV infection (baseline CD4 count per 50 cells/μl increase OR 1.4, 95%CI 0.9-2.2). A total of 14 (31%) patients died before initiating ART; the monthly incidence of death did not decrease over the 6-month interval. CONCLUSION: The high mortality observed within the 6 months following hospitalization with TB or other acute OIs indicate that mechanisms are needed to expedite ART for patients after an acquired immune-deficiency syndrome defining illness.

Original languageEnglish (US)
Pages (from-to)903-908
Number of pages6
JournalInternational Journal of Tuberculosis and Lung Disease
Volume14
Issue number7
StatePublished - 2010
Externally publishedYes

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South Africa
Tuberculosis
HIV
Opportunistic Infections
CD4 Lymphocyte Count
Therapeutics
Implosive Therapy
Cryptococcal Meningitis
Pneumocystis Pneumonia
Lost to Follow-Up
Incidence
Toxoplasma
Traditional Medicine
Virus Diseases
Inpatients
Diarrhea
Acquired Immunodeficiency Syndrome
Hospitalization
Cohort Studies
Logistic Models

Keywords

  • Antiretroviral therapy
  • Co-infection
  • Tuberculosis

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Infectious Diseases
  • Medicine(all)

Cite this

Murphy, R. A., Sunpath, H., Taha, B., Kappagoda, S., Maphasa, K. T. M., Kuritzkes, D. R., & Smeaton, L. (2010). Low uptake of antiretroviral therapy after admission with human immunodeficiency virus and tuberculosis in KwaZulu-Natal, South Africa. International Journal of Tuberculosis and Lung Disease, 14(7), 903-908.

Low uptake of antiretroviral therapy after admission with human immunodeficiency virus and tuberculosis in KwaZulu-Natal, South Africa. / Murphy, Richard A.; Sunpath, H.; Taha, B.; Kappagoda, S.; Maphasa, K. T M; Kuritzkes, D. R.; Smeaton, L.

In: International Journal of Tuberculosis and Lung Disease, Vol. 14, No. 7, 2010, p. 903-908.

Research output: Contribution to journalArticle

Murphy, RA, Sunpath, H, Taha, B, Kappagoda, S, Maphasa, KTM, Kuritzkes, DR & Smeaton, L 2010, 'Low uptake of antiretroviral therapy after admission with human immunodeficiency virus and tuberculosis in KwaZulu-Natal, South Africa', International Journal of Tuberculosis and Lung Disease, vol. 14, no. 7, pp. 903-908.
Murphy, Richard A. ; Sunpath, H. ; Taha, B. ; Kappagoda, S. ; Maphasa, K. T M ; Kuritzkes, D. R. ; Smeaton, L. / Low uptake of antiretroviral therapy after admission with human immunodeficiency virus and tuberculosis in KwaZulu-Natal, South Africa. In: International Journal of Tuberculosis and Lung Disease. 2010 ; Vol. 14, No. 7. pp. 903-908.
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