Author | Chaisson, Lelia H. | |
Author | Saraceni, Valeria | |
Author | Cohn, Silvia | |
Author | Seabrook, Dena | |
Author | Cavalcante, Solange C. | |
Author | Chaisson, Richard E. | |
Author | Golub, Jonathan E. | |
Author | Durovni, Betina | |
Access date | 2020-03-24T13:54:38Z | |
Available date | 2020-03-24T13:54:38Z | |
Document date | 2020 | |
Citation | CHAISSON, Lelia H. et al. CD4+ cell count stratification to guide tuberculosis preventive therapy for people living with HIV. AIDS, v. 34, n. 1, p. 139-147, 2020. | pt_BR |
ISSN | 0269-9370 | pt_BR |
URI | https://www.arca.fiocruz.br/handle/icict/40471 | |
Language | eng | pt_BR |
Publisher | Lippincott, Williams & Wilkins | pt_BR |
Rights | restricted access | pt_BR |
Title | CD4+ cell count stratification to guide tuberculosis preventive therapy for people living with HIV | pt_BR |
Type | Article | pt_BR |
DOI | 10.1097/QAD.0000000000002398 | |
Abstract | Objectives: In 2018, Brazilian guidelines changed to recommend tuberculosis (TB) preventive therapy for all people with HIV and a CD4þ cell count 350 cells/ml or less, but only for those with a positive tuberculin skin test (TST) if CD4þ cell count is than 350 cells/ml. We determined the potential effectiveness of CD4þ-based guidelines for TB testing and preventive therapy. Design: Secondary analysis of the stepped-wedge, cluster-randomized THRio trial for isoniazid preventive therapy (IPT).
Methods: We analyzed data from 4114 newly registered patients with HIV in 29 clinics followed until TB diagnosis, death, or administrative censoring. We compared incidence rates of TB and TB/death between CD4þ, TST, IPT, and antiretroviral therapy categories. Results: Initial CD4þ cell count was 350 cells/ml or less in 2138 (52%) and more than 350 cells/mlin 1976 (48%) patients. TST was performed for 2922 (71%), ofwhom657(16%)
were TST-positive [278 (13%) CD4þ 350 vs. 379 (19%) CD4þ > 350]. A total of 619 (15%) received IPT and 2806 (68%) received antiretroviral therapy. For patients with CD4þ cellcount 350 cells/mlor less who did not receive IPT, the incidence rate of TB was 1.79/100 person-years (pys) and TB/death was 3.89/100 pys. For patients with CD4þ cell count more than 350 who did not receive IPT, the incidence rates of TB and TB/death were 0.57/100 and 1.49/100 pys for TST-negatives, and 1.05/100 and 1.64/100 pys for TST-unknowns. Conclusion: TB incidence was high among all patients who did not receive IPT, including those with CD4þ cell count more than 350 cells/ml and negative or unknown TST results. TB preventive therapy should be provided to all people living with HIV in medium burden settings, regardless of CD4þ cell count and TST status. | pt_BR |
Affilliation | Department of Epidemiology. Johns Hopkins Bloomberg School of Public Health. Baltimore, Maryland, USA. | pt_BR |
Affilliation | Municipal Health Secretariat. Rio de Janeiro, Brazil. | pt_BR |
Affilliation | Department of Medicine. Center for Tuberculosis Research. Johns Hopkins University School of Medicine. Baltimore, Maryland, USA. | pt_BR |
Affilliation | Linksbridge SPC. Seattle, Washington, USA. | pt_BR |
Affilliation | Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Rio de Janeiro, RJ, Brasil / Municipal Health Secretariat, Rio de Janeiro, Brazil. | pt_BR |
Affilliation | Department of Epidemiology. Johns Hopkins Bloomberg School of Public Health. Baltimore, Maryland, USA / Department of Medicine. Center for Tuberculosis Research. Johns Hopkins University School of Medicine. Baltimore, Maryland, USA. | pt_BR |
Affilliation | Department of Epidemiology. Johns Hopkins Bloomberg School of Public Health. Baltimore, Maryland, USA / Department of Medicine. Center for Tuberculosis Research. Johns Hopkins University School of Medicine. Baltimore, Maryland, USA. | pt_BR |
Affilliation | Fundação Oswaldo Cruz. Centro de Estudos Estratégicos. Rio de Janeiro, RJ, Brasil / Municipal Health Secretariat, Rio de Janeiro, Brasil. | pt_BR |
Subject | HIV | pt_BR |
Subject | Latent tuberculosis infection | pt_BR |
Subject | Tuberculin skin testing | pt_BR |
Subject | Tuberculosis | pt_BR |
Subject | Tuberculosis preventive therapy | pt_BR |
Embargo date | 2051-01-01 | |