Operationalizing early antiretroviral therapy in HIV-infected in-patients with opportunistic infections including tuberculosis

Henry Sunpath, C. Edwin, N. Chelin, S. Nadesan, R. Maharaj, Y. Moosa, L. Smeaton, R. Court, S. Knight, E. Gwyther, R. A. Murphy

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

BACKGROUND: We describe the outcomes of a program in which antiretroviral therapy (ART) is offered to human immunodeficiency virus (HIV) infected patients in South Africa admitted with tuberculosis (TB) or other opportunistic infection (OI) as part of in-patient care. METHODS: Patients admitted with HIV and concurrent TB or other OI were initiated on early in-patient ART. The primary and secondary endpoints were respectively 24-week mortality and 24-week virologic suppression. Multivariable logistic regression modeling explored the associations between baseline (i.e., pre-hospital discharge) characteristics and mortality at 24 weeks. RESULTS: A total of 382 patients were prospectively enrolled (48% women, median age 37 years, median CD4 count 33 cells/mm 3). Acute OIs were pulmonary TB, 39%; extra-pulmonary TB, 25%; cryptococcal meningitis (CM), 10%; and chronic diarrhea, 9%. The median time from admission to ART initiation was 14 days (range 4-32, IQR 11-18). At 24 weeks of follow-up, astreated and intention-to-treat virologic suppression were respectively 57% and 93%. Median change in CD4 cell count was +100 cells/mm3, overall 24-week mortality was 25% and loss to follow-up, 5%. Excess mortality was not observed among patients with CM who initiated early ART. A longer interval between admission and ART was associated with mortality (>21 days vs. <21 days after admission OR 2.1, 95%CI 1.2-4.0, P =0.016). CONCLUSIONS: For HIV-infected in-patients with TB or an acquired immune-deficiency syndrome defining OI, we demonstrate the operational feasibility of early ART initiation in in-patients.

Original languageEnglish (US)
Pages (from-to)917-923
Number of pages7
JournalInternational Journal of Tuberculosis and Lung Disease
Volume16
Issue number7
DOIs
StatePublished - Jul 1 2012
Externally publishedYes

Fingerprint

Opportunistic Infections
Secondary Prevention
Tuberculosis
HIV
Mortality
Cryptococcal Meningitis
CD4 Lymphocyte Count
Pulmonary Tuberculosis
Therapeutics
South Africa
Diarrhea
Patient Care
Acquired Immunodeficiency Syndrome
Logistic Models

Keywords

  • Antiviral therapy
  • Operational research
  • Resource-limited settings

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Infectious Diseases

Cite this

Operationalizing early antiretroviral therapy in HIV-infected in-patients with opportunistic infections including tuberculosis. / Sunpath, Henry; Edwin, C.; Chelin, N.; Nadesan, S.; Maharaj, R.; Moosa, Y.; Smeaton, L.; Court, R.; Knight, S.; Gwyther, E.; Murphy, R. A.

In: International Journal of Tuberculosis and Lung Disease, Vol. 16, No. 7, 01.07.2012, p. 917-923.

Research output: Contribution to journalArticle

Sunpath, H, Edwin, C, Chelin, N, Nadesan, S, Maharaj, R, Moosa, Y, Smeaton, L, Court, R, Knight, S, Gwyther, E & Murphy, RA 2012, 'Operationalizing early antiretroviral therapy in HIV-infected in-patients with opportunistic infections including tuberculosis', International Journal of Tuberculosis and Lung Disease, vol. 16, no. 7, pp. 917-923. https://doi.org/10.5588/ijtld.11.0651
Sunpath, Henry ; Edwin, C. ; Chelin, N. ; Nadesan, S. ; Maharaj, R. ; Moosa, Y. ; Smeaton, L. ; Court, R. ; Knight, S. ; Gwyther, E. ; Murphy, R. A. / Operationalizing early antiretroviral therapy in HIV-infected in-patients with opportunistic infections including tuberculosis. In: International Journal of Tuberculosis and Lung Disease. 2012 ; Vol. 16, No. 7. pp. 917-923.
@article{840d8fef5f4a489fa6d4a787840971ce,
title = "Operationalizing early antiretroviral therapy in HIV-infected in-patients with opportunistic infections including tuberculosis",
abstract = "BACKGROUND: We describe the outcomes of a program in which antiretroviral therapy (ART) is offered to human immunodeficiency virus (HIV) infected patients in South Africa admitted with tuberculosis (TB) or other opportunistic infection (OI) as part of in-patient care. METHODS: Patients admitted with HIV and concurrent TB or other OI were initiated on early in-patient ART. The primary and secondary endpoints were respectively 24-week mortality and 24-week virologic suppression. Multivariable logistic regression modeling explored the associations between baseline (i.e., pre-hospital discharge) characteristics and mortality at 24 weeks. RESULTS: A total of 382 patients were prospectively enrolled (48{\%} women, median age 37 years, median CD4 count 33 cells/mm 3). Acute OIs were pulmonary TB, 39{\%}; extra-pulmonary TB, 25{\%}; cryptococcal meningitis (CM), 10{\%}; and chronic diarrhea, 9{\%}. The median time from admission to ART initiation was 14 days (range 4-32, IQR 11-18). At 24 weeks of follow-up, astreated and intention-to-treat virologic suppression were respectively 57{\%} and 93{\%}. Median change in CD4 cell count was +100 cells/mm3, overall 24-week mortality was 25{\%} and loss to follow-up, 5{\%}. Excess mortality was not observed among patients with CM who initiated early ART. A longer interval between admission and ART was associated with mortality (>21 days vs. <21 days after admission OR 2.1, 95{\%}CI 1.2-4.0, P =0.016). CONCLUSIONS: For HIV-infected in-patients with TB or an acquired immune-deficiency syndrome defining OI, we demonstrate the operational feasibility of early ART initiation in in-patients.",
keywords = "Antiviral therapy, Operational research, Resource-limited settings",
author = "Henry Sunpath and C. Edwin and N. Chelin and S. Nadesan and R. Maharaj and Y. Moosa and L. Smeaton and R. Court and S. Knight and E. Gwyther and Murphy, {R. A.}",
year = "2012",
month = "7",
day = "1",
doi = "10.5588/ijtld.11.0651",
language = "English (US)",
volume = "16",
pages = "917--923",
journal = "International Journal of Tuberculosis and Lung Disease",
issn = "1027-3719",
publisher = "International Union against Tubercul. and Lung Dis.",
number = "7",

}

TY - JOUR

T1 - Operationalizing early antiretroviral therapy in HIV-infected in-patients with opportunistic infections including tuberculosis

AU - Sunpath, Henry

AU - Edwin, C.

AU - Chelin, N.

AU - Nadesan, S.

AU - Maharaj, R.

AU - Moosa, Y.

AU - Smeaton, L.

AU - Court, R.

AU - Knight, S.

AU - Gwyther, E.

AU - Murphy, R. A.

PY - 2012/7/1

Y1 - 2012/7/1

N2 - BACKGROUND: We describe the outcomes of a program in which antiretroviral therapy (ART) is offered to human immunodeficiency virus (HIV) infected patients in South Africa admitted with tuberculosis (TB) or other opportunistic infection (OI) as part of in-patient care. METHODS: Patients admitted with HIV and concurrent TB or other OI were initiated on early in-patient ART. The primary and secondary endpoints were respectively 24-week mortality and 24-week virologic suppression. Multivariable logistic regression modeling explored the associations between baseline (i.e., pre-hospital discharge) characteristics and mortality at 24 weeks. RESULTS: A total of 382 patients were prospectively enrolled (48% women, median age 37 years, median CD4 count 33 cells/mm 3). Acute OIs were pulmonary TB, 39%; extra-pulmonary TB, 25%; cryptococcal meningitis (CM), 10%; and chronic diarrhea, 9%. The median time from admission to ART initiation was 14 days (range 4-32, IQR 11-18). At 24 weeks of follow-up, astreated and intention-to-treat virologic suppression were respectively 57% and 93%. Median change in CD4 cell count was +100 cells/mm3, overall 24-week mortality was 25% and loss to follow-up, 5%. Excess mortality was not observed among patients with CM who initiated early ART. A longer interval between admission and ART was associated with mortality (>21 days vs. <21 days after admission OR 2.1, 95%CI 1.2-4.0, P =0.016). CONCLUSIONS: For HIV-infected in-patients with TB or an acquired immune-deficiency syndrome defining OI, we demonstrate the operational feasibility of early ART initiation in in-patients.

AB - BACKGROUND: We describe the outcomes of a program in which antiretroviral therapy (ART) is offered to human immunodeficiency virus (HIV) infected patients in South Africa admitted with tuberculosis (TB) or other opportunistic infection (OI) as part of in-patient care. METHODS: Patients admitted with HIV and concurrent TB or other OI were initiated on early in-patient ART. The primary and secondary endpoints were respectively 24-week mortality and 24-week virologic suppression. Multivariable logistic regression modeling explored the associations between baseline (i.e., pre-hospital discharge) characteristics and mortality at 24 weeks. RESULTS: A total of 382 patients were prospectively enrolled (48% women, median age 37 years, median CD4 count 33 cells/mm 3). Acute OIs were pulmonary TB, 39%; extra-pulmonary TB, 25%; cryptococcal meningitis (CM), 10%; and chronic diarrhea, 9%. The median time from admission to ART initiation was 14 days (range 4-32, IQR 11-18). At 24 weeks of follow-up, astreated and intention-to-treat virologic suppression were respectively 57% and 93%. Median change in CD4 cell count was +100 cells/mm3, overall 24-week mortality was 25% and loss to follow-up, 5%. Excess mortality was not observed among patients with CM who initiated early ART. A longer interval between admission and ART was associated with mortality (>21 days vs. <21 days after admission OR 2.1, 95%CI 1.2-4.0, P =0.016). CONCLUSIONS: For HIV-infected in-patients with TB or an acquired immune-deficiency syndrome defining OI, we demonstrate the operational feasibility of early ART initiation in in-patients.

KW - Antiviral therapy

KW - Operational research

KW - Resource-limited settings

UR - http://www.scopus.com/inward/record.url?scp=84862170749&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84862170749&partnerID=8YFLogxK

U2 - 10.5588/ijtld.11.0651

DO - 10.5588/ijtld.11.0651

M3 - Article

VL - 16

SP - 917

EP - 923

JO - International Journal of Tuberculosis and Lung Disease

JF - International Journal of Tuberculosis and Lung Disease

SN - 1027-3719

IS - 7

ER -