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Tuberculosis, HAART Use and Survival in THRio Cohort, Rio de Janeiro, Brazil

Tuberculosis, HAART Use and Survival in THRio Cohort, Rio de Janeiro, Brazil. Saraceni V 1 , King B 2 , Pacheco AG 3 , Golub JE 2 , Cavalcante SC 1 , Moulton LH 2 , Moore RD 2 , Chaisson RE 2 , Durovni B 1

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Tuberculosis, HAART Use and Survival in THRio Cohort, Rio de Janeiro, Brazil

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  1. Tuberculosis, HAART Use and Survival in THRio Cohort, Rio de Janeiro, Brazil Saraceni V1, King B2, Pacheco AG3, Golub JE2, Cavalcante SC1, Moulton LH2, Moore RD2, Chaisson RE2, Durovni B1 1-Rio de Janeiro City Health Dept., Rio de Janeiro, Brazil; 2 – Johns Hopkins SM, CTBR, Bloomberg SPH, JH HIV Clinic, Baltimore, USA; 3 – DEMQS, Fiocruz, Rio de Janeiro, Brazil Abstract MOAB0305

  2. Background • Questions remain concerning the best time to initiate HAART after TB diagnosis • THRio – Observational cohort study to assess impact of TB screening and INH preventive therapy on TB incidence • Universal access to HAART in Brazil • High TB-burden scenario – common first HIV diagnosis and leading cause of death in HIV patients1 1. Saraceni et al., IJTLD 2008;12:769

  3. Objectives • Compare survival after TB diagnosis in HIV-positive subjects followed at 29 health units in Rio de Janeiro • Comparisons: • exposure to HAART vs. no HAART in the overall group • among those who initiated HAART, timing of initiation of ARV therapy: • Early HAART (<60 days of TB therapy) • Deferred HAART (61-180 days of TB therapy) • Withheld HAART (> 180 days of TB therapy)

  4. Methods • Inclusion Criteria: • First episode of TB diagnosed from 01 Sep 2003 to 30 Jun 2006 • HIV diagnosed either before or after TB • Right censored at last note in chart or 31 Dec 2006 • Mortality data available through State surveillance system up to 31 Dec 2006 • Statistical Analysis: • Descriptive statistics • Kaplan-Meier estimates • Cox proportional hazards regression models

  5. Results • At time of this analysis: • 15,426 HIV+ patients receiving care in Rio City clinics • 963 (6%) new TB cases diagnosed from 01 Sep 2003 to 30 Jun 2006 • 632 (66%) patients were HAART-naive at time of TB diagnosis • 459 (73%) started HAART in the follow-up period • 85/632 TB patients (13%) died during follow up

  6. Table 1 – Characteristics of subjects by survival status

  7. Table 2 – Characteristics of subjects by exposure to HAART

  8. Table 3 – Characteristics of subjects by timing of exposure to HAART

  9. Table 4 – Time to HIV diagnosis after TB episode among those exposed to HAART

  10. Graph 1 – Kaplan-Meier: Survival After a TB diagnosis, by exposure to HAART Log-rank test – p<.001

  11. Graph 2 – Kaplan-Meier: Survival After a TB diagnosis, by completion of TB treatment Log-rank test – p<.001

  12. Graph 3 – Kaplan-Meier: Survival After a TB diagnosis, by completion of TB treatment, of those who survived longer than 180 days Log-rank test – p<. 001

  13. Graph 4– Kaplan-Meier: Survival After a TB diagnosis, by CD4 category Log-rank test – p=.985

  14. Graph 5 – Kaplan-Meier: Survival After a TB diagnosis, by timing of TB and HIV diagnosis Log-rank test – p=.018

  15. Graph 6 – Kaplan-Meier: Time to HAART: <=60, 61-180 or > 180 days after TB treatment started Log-rank test – p=.306

  16. Table 5: Cox model – Univariate analysis, all cases

  17. Table 6: Final Cox model, all cases

  18. Conclusions • HAART exposure significantly related to improved survival after TB diagnosis (univariate HR=0.30; aHR=0.48) • The benefits of HAART were found despite lower median CD4 counts in those who received it vs. those who did not • Time of initiation of HAART not associated with significant changes in survival • Delays in diagnosis HIV in TB patients associated with lower likelihood of receiving HAART • Universal opt-out testing for all TB patients essential

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