Clinical deterioration during antituberculosis treatment in Africa: Incidence, causes and risk factors

被引：23

作者：

Pepper, Dominique J. ^{[1
,2
]}

Marais, Suzaan ^{[1
,2
]}

Wilkinson, Robert J. ^{[1
,2
,4
,5
]}

Bhaijee, Feriyl ^{[6
]}

Maartens, Gary ^{[3
]}

McIlleron, Helen ^{[3
]}

De Azevedo, Virginia ^{[7
]}

Cox, Helen

McDermid, Cheryl ^{[8
]}

Sokhela, Simiso ^{[7
]}

Patel, Janisha ^{[2
]}

Meintjes, Graeme ^{[1
,2
]}

机构：

[1] GF Jooste Hosp, Infect Dis Unit, Cape Town, South Africa

[2] Univ Cape Town, Inst Infect Dis & Mol Med, ZA-7700 Rondebosch, South Africa

[3] Univ Cape Town, Dept Med, Div Clin Pharmacol, ZA-7700 Rondebosch, South Africa

[4] Univ London Imperial Coll Sci Technol & Med, Div Med, London, England

[5] MRC Natl Inst Med Res, London NW7 1AA, England

[6] Groote Schuur Hosp, ZA-7925 Cape Town, South Africa

[7] City Hlth, Khayelitsha Site TB Clin B, Cape Town, South Africa

[8] MedecinsSans Frontieres, Cape Town, South Africa

来源：

BMC INFECTIOUS DISEASES | 2010年 / 10卷

基金：

英国惠康基金;

关键词：

ACTIVE ANTIRETROVIRAL THERAPY; HUMAN-IMMUNODEFICIENCY-VIRUS; RECONSTITUTION INFLAMMATORY SYNDROME; RURAL SOUTH-AFRICA; DRUG-RESISTANCE; TUBERCULOSIS; MORTALITY; INFECTION; ADULTS; IMPACT;

D O I：

10.1186/1471-2334-10-83

中图分类号：

R51 [传染病];

学科分类号：

100401 ;

摘要：

Background: HIV-1 and Mycobacterium tuberculosis cause substantial morbidity and mortality. Despite the availability of antiretroviral and antituberculosis treatment in Africa, clinical deterioration during antituberculosis treatment remains a frequent reason for hospital admission. We therefore determined the incidence, causes and risk factors for clinical deterioration. Methods: Prospective cohort study of 292 adults who initiated antituberculosis treatment during a 3-month period. We evaluated those with clinical deterioration over the following 24 weeks of treatment. Results: Seventy-one percent (209/292) of patients were HIV-1 infected (median CD4+: 129 cells/mu L [IQR:62-277]). At tuberculosis diagnosis, 23% (34/145) of HIV-1 infected patients qualifying for antiretroviral treatment (ART) were receiving ART; 6 months later, 75% (109/145) had received ART. Within 24 weeks of initiating antituberculosis treatment, 40% (117/292) of patients experienced clinical deterioration due to co-morbid illness (n = 70), tuberculosis related illness (n = 47), non AIDS-defining HIV-1 related infection (n = 25) and AIDS-defining illness (n = 21). Using HIV-1 uninfected patients as the referent group, HIV-1 infected patients had an increasing risk of clinical deterioration as CD4+ counts decreased [CD4+>350 cells/mu L: RR = 1.4, 95% CI = 0.7-2.9; CD4+: 200-350 cells/mu L: RR = 2.0, 95% CI = 1.1-3.6; CD4+<200 cells/mu L: RR = 3.0, 95% CI = 1.9-4.7]. During follow-up, 26% (30/117) of patients with clinical deterioration required hospital admission and 15% (17/117) died. Fifteen deaths were in HIV-1 infected patients with a CD4+<200 cells/mu L. Conclusions: In multivariate analysis, HIV-1 infection and a low CD4+ count at tuberculosis diagnosis were significant risk factors for clinical deterioration and death. The initiation of ART at a CD4+ count of <350 cells/mu L will likely reduce the high burden of clinical deterioration.

引用

页数：11

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