Cargando…

Challenges Across the HIV Care Continuum for Patients With HIV/TB Co-infection in Atlanta, GA

BACKGROUND: Antiretroviral therapy (ART) for persons with HIV infection prevents tuberculosis (TB) disease. Additionally, sequential ART after initiation of TB treatment improves outcomes. We examined ART use, retention in care, and viral suppression (VS) before, during, and 3 years following TB tre...

Descripción completa

Detalles Bibliográficos
Autores principales: Schechter, Marcos C, Bizune, Destani, Kagei, Michelle, Holland, David P, del Rio, Carlos, Yamin, Aliya, Mohamed, Omar, Oladele, Alawode, Wang, Yun F, Rebolledo, Paulina A, Ray, Susan M, Kempker, Russell R
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5890473/
https://www.ncbi.nlm.nih.gov/pubmed/29657955
http://dx.doi.org/10.1093/ofid/ofy063
_version_ 1783312874946428928
author Schechter, Marcos C
Bizune, Destani
Kagei, Michelle
Holland, David P
del Rio, Carlos
Yamin, Aliya
Mohamed, Omar
Oladele, Alawode
Wang, Yun F
Rebolledo, Paulina A
Ray, Susan M
Kempker, Russell R
author_facet Schechter, Marcos C
Bizune, Destani
Kagei, Michelle
Holland, David P
del Rio, Carlos
Yamin, Aliya
Mohamed, Omar
Oladele, Alawode
Wang, Yun F
Rebolledo, Paulina A
Ray, Susan M
Kempker, Russell R
author_sort Schechter, Marcos C
collection PubMed
description BACKGROUND: Antiretroviral therapy (ART) for persons with HIV infection prevents tuberculosis (TB) disease. Additionally, sequential ART after initiation of TB treatment improves outcomes. We examined ART use, retention in care, and viral suppression (VS) before, during, and 3 years following TB treatment for an inner-city cohort in the United States. METHODS: Retrospective cohort study among persons treated for culture-confirmed TB between 2008 and 2015 at an inner-city hospital. RESULTS: Among 274 persons with culture-confirmed TB, 96 (35%) had HIV co-infection, including 23 (24%) new HIV diagnoses and 73 (76%) previous diagnoses. Among those with known HIV prior to TB, the median time of known HIV was 6 years, and only 10 (14%) were on ART at the time of TB diagnosis. The median CD4 at TB diagnosis was 87 cells/uL. Seventy-four (81%) patients received ART during treatment for TB, and 47 (52%) has VS at the end of TB treatment. Only 32% of patients had continuous VS 3 years after completing TB treatment. There were 3 TB recurrences and 3 deaths post–TB treatment; none of these patients had retention or VS after TB treatment. CONCLUSIONS: Among persons with active TB co-infected with HIV, we found that the majority had known HIV and were not on ART prior to TB diagnosis, and retention in care and VS post–TB treatment were very low. Strengthening the HIV care continuum is needed to improve HIV outcomes and further reduce rates of active TB/HIV co-infection in our and similar settings.
format Online
Article
Text
id pubmed-5890473
institution National Center for Biotechnology Information
language English
publishDate 2018
publisher Oxford University Press
record_format MEDLINE/PubMed
spelling pubmed-58904732018-04-13 Challenges Across the HIV Care Continuum for Patients With HIV/TB Co-infection in Atlanta, GA Schechter, Marcos C Bizune, Destani Kagei, Michelle Holland, David P del Rio, Carlos Yamin, Aliya Mohamed, Omar Oladele, Alawode Wang, Yun F Rebolledo, Paulina A Ray, Susan M Kempker, Russell R Open Forum Infect Dis Major Article BACKGROUND: Antiretroviral therapy (ART) for persons with HIV infection prevents tuberculosis (TB) disease. Additionally, sequential ART after initiation of TB treatment improves outcomes. We examined ART use, retention in care, and viral suppression (VS) before, during, and 3 years following TB treatment for an inner-city cohort in the United States. METHODS: Retrospective cohort study among persons treated for culture-confirmed TB between 2008 and 2015 at an inner-city hospital. RESULTS: Among 274 persons with culture-confirmed TB, 96 (35%) had HIV co-infection, including 23 (24%) new HIV diagnoses and 73 (76%) previous diagnoses. Among those with known HIV prior to TB, the median time of known HIV was 6 years, and only 10 (14%) were on ART at the time of TB diagnosis. The median CD4 at TB diagnosis was 87 cells/uL. Seventy-four (81%) patients received ART during treatment for TB, and 47 (52%) has VS at the end of TB treatment. Only 32% of patients had continuous VS 3 years after completing TB treatment. There were 3 TB recurrences and 3 deaths post–TB treatment; none of these patients had retention or VS after TB treatment. CONCLUSIONS: Among persons with active TB co-infected with HIV, we found that the majority had known HIV and were not on ART prior to TB diagnosis, and retention in care and VS post–TB treatment were very low. Strengthening the HIV care continuum is needed to improve HIV outcomes and further reduce rates of active TB/HIV co-infection in our and similar settings. Oxford University Press 2018-03-21 /pmc/articles/PMC5890473/ /pubmed/29657955 http://dx.doi.org/10.1093/ofid/ofy063 Text en © The Author(s) 2018. Published by Oxford University Press on behalf of Infectious Diseases Society of America. http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Major Article
Schechter, Marcos C
Bizune, Destani
Kagei, Michelle
Holland, David P
del Rio, Carlos
Yamin, Aliya
Mohamed, Omar
Oladele, Alawode
Wang, Yun F
Rebolledo, Paulina A
Ray, Susan M
Kempker, Russell R
Challenges Across the HIV Care Continuum for Patients With HIV/TB Co-infection in Atlanta, GA
title Challenges Across the HIV Care Continuum for Patients With HIV/TB Co-infection in Atlanta, GA
title_full Challenges Across the HIV Care Continuum for Patients With HIV/TB Co-infection in Atlanta, GA
title_fullStr Challenges Across the HIV Care Continuum for Patients With HIV/TB Co-infection in Atlanta, GA
title_full_unstemmed Challenges Across the HIV Care Continuum for Patients With HIV/TB Co-infection in Atlanta, GA
title_short Challenges Across the HIV Care Continuum for Patients With HIV/TB Co-infection in Atlanta, GA
title_sort challenges across the hiv care continuum for patients with hiv/tb co-infection in atlanta, ga
topic Major Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5890473/
https://www.ncbi.nlm.nih.gov/pubmed/29657955
http://dx.doi.org/10.1093/ofid/ofy063
work_keys_str_mv AT schechtermarcosc challengesacrossthehivcarecontinuumforpatientswithhivtbcoinfectioninatlantaga
AT bizunedestani challengesacrossthehivcarecontinuumforpatientswithhivtbcoinfectioninatlantaga
AT kageimichelle challengesacrossthehivcarecontinuumforpatientswithhivtbcoinfectioninatlantaga
AT hollanddavidp challengesacrossthehivcarecontinuumforpatientswithhivtbcoinfectioninatlantaga
AT delriocarlos challengesacrossthehivcarecontinuumforpatientswithhivtbcoinfectioninatlantaga
AT yaminaliya challengesacrossthehivcarecontinuumforpatientswithhivtbcoinfectioninatlantaga
AT mohamedomar challengesacrossthehivcarecontinuumforpatientswithhivtbcoinfectioninatlantaga
AT oladelealawode challengesacrossthehivcarecontinuumforpatientswithhivtbcoinfectioninatlantaga
AT wangyunf challengesacrossthehivcarecontinuumforpatientswithhivtbcoinfectioninatlantaga
AT rebolledopaulinaa challengesacrossthehivcarecontinuumforpatientswithhivtbcoinfectioninatlantaga
AT raysusanm challengesacrossthehivcarecontinuumforpatientswithhivtbcoinfectioninatlantaga
AT kempkerrussellr challengesacrossthehivcarecontinuumforpatientswithhivtbcoinfectioninatlantaga