There is life with HIV

ART during TB therapy reduces mortality risk for HIV-positive people co-infected with tuberculosis

I saw one person, Waldir, die of TB. But it was not pulmonary tuberculosis and, yes, miliary tuberculosis that, according to the doctor explained to me, is tuberculosis spread all over the body. I, who for a time, for reasons not to mention here, had a weight removed from my shoulders, after all, without having been the will of God who took it and, indeed, would have been a great selfishness of mine I asked her to stay, even for another week ...

Hispanic woman feeling nausea or coughingThere is a high mortality rate among people living with HIV undergoing treatment for tuberculosis (TB), according to the results of a meta-analysis published in PLOS One . The death rate varied between 8 and 14%, but the risk of death was significantly lower for people who received antiretroviral treatment (ART) during their tuberculosis therapy.

"This is the first systematic assessment to quantify the impact of ART on TB mortality in the treatment of TB", comment the authors. “We estimate that mortality during treatment of tuberculosis in individuals with HIV infection receiving ART in routine programmatic conditions is between 8% and 14% and that ART reduces mortality during treatment of TB in HIV-positive TB patients among 44 % and 71% ”.

The researchers believe their findings show the importance of collaboration between tuberculosis therapy and HIV testing in treatment services.

TB is a major cause of death among people infected with HIV. Although only 13% of all individuals with tuberculosis co-infected with HIV, these patients are responsible for about a quarter of all TB deaths.

Sub-Saharan Africa accounts for 75% of all tuberculosis cases in people with HIV, and in 2012 about a quarter of a million deaths occurred among people with HIV and tuberculosis co-infections in this region.

Aerial view of Dakar
Visar Aérea de Dakar

More than half (57%) of HIV-positive patients co-infected with TB now receive ART. ART is known to reduce the risk of a TB incident and is also associated with better outcomes in HIV-positive patients receiving simultaneous treatment for TB.

However, no systematic review had previously evaluated the benefits of ART in relation to TB mortality.

An international team of researchers, therefore, performed a meta-analysis of studies carried out between the years 1996 and 2013 to estimate the mortality rate among HIV-positive patients and people co-infected with TB who underwent therapy and use of ART. Where possible, they will also be assessed in comparing the risk of mortality between people receiving ART and those who have remained on ART.

A total of 21 studies were included in the analysis. The majority (11, 52%) were conducted in sub-Saharan Africa and Southeast Asia (7 th, 33%). The majority (13, 62%) were retrospective cohort studies, with seven prospective cohort studies and was a clinical trial.

The number of patients in each study ranged from 75 to 21.851 (median, 191). Median CD4 count was available to participants in four studies and was between 48 to 152 cells / mm3.

The mortality rate ranged from 8 to 14%. It tended to be higher in Africa (11-17%) than Southeast Asia (7-15%).

Eleven studies reported the relative risk of mortality compared to patients on HIV treatment.

ART during TB therapy reduced the risk of mortality by 68% (RR = 0,64; 95% CI 0,29 -0,56).

"We quantified the substantial impact of ART on reducing mortality during tuberculosis treatment," conclude the authors. They note that HAART collaboratively working on tuberculosis programs are key components of the new global TB strategy, recently approved by the World Health Assembly and that “these interventions promise to reduce delays in diagnosing HIV infection, facilitate rapid implementation of effective ART and reduce TB mortality in HIV-positive patients ”.

Reference

Odone et al. The impact of antiretroviral therapy on mortality in HIV-positive people during treatment for tuberculosis: a systematic review and meta-analysis.A PLOS One 9 (11): e112017. DOI: 10.1371 / oficial.pone.0112017 (2014).

This report is also available in Russian.

Michael Carter

Published: December 19, 2014.

Claudio Souza
This is responsible for the translation and adaptation to Portuguese of Brazil

 

Editor's note: Well after I received the diagnosis I went to live in a support house, Brenda Lee. According to the doctor who took care of all the patients in the support house where I lived, she was a focus of tuberculosis and I had to do a long prophylactic treatment; as a matter of fact, the girl who had passed me HIV, had also been a victim of tuberculosis and prophylaxis could not be ruled out with ease. this happened so long ago that i remember having done the PPD (...) and it gave reagent, yes, for TB and, therefore, the treatment came in handy.

I cannot, for ethical reasons, tell what I saw, heard and lived in this and another support house (I stayed in two for a brief period of six months and ended up choosing to live on the streets and get up from there) ), but, believe me, I saw enough and said to my wife, and soon I will tell a friend that, if the only alternative for me is a support house, they will shoot me in the head. Turns and moves someone writes to me, full of fingers, explaining the inexplicable, trying to give me some guidance on how to hospitalize (…) someone in one of these places. I don't even answer. It is useless to seek this information from me and there is even the possibility of receiving a “crossed” answer.

Translation, revision, adaptation and edition of the original in English ART during tuberculosis therapy reduces mortality risk for people with HIV by Claudio Souza on 15/04/2015

Reproduction of the whole or partial translated text is allowed, provided that all credits, including the original source are placed.

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