L King1, S S Munsiff, S D Ahuja. 1. New York City Department of Health and Mental Hygiene, New York, New York 10007, USA. lking@health.nyc.gov
Abstract
OBJECTIVE: To review outcomes of human immunodeficiency virus (HIV) positive tuberculosis (TB) patients in New York City (NYC) to determine if the World Health Organization treatment success target of 85% was met in a setting with ready access to treatment for HIV and TB. DESIGN: Retrospective review of new TB patients diagnosed from 1995 to 2004, excluding patients with rifampin (RMP) resistance. RESULTS: Of 9198 eligible TB patients, 83% had achieved treatment success, 8% died during treatment, 4% failed, 3% defaulted and 2% were transferred from NYC. Among 6374 HIV-negative individuals, treatment success was consistently over 85%; 5% died during treatment. Among 2824 HIV-positive individuals, treatment success was 72% overall and 66% in sputum acid-fast bacilli smear-positive patients. Mortality among the HIV-positive decreased from 26% in 1995 to 14% in 2004. HIV-positive patients achieved higher treatment success if 1) they received treatment by directly observed therapy (DOT) (82% vs. 74%, OR(adj) = 1.80, 95%CI 1.44-2.26), or 2) were administered rifabutin (RFB) in the regimen, a proxy for receiving antiretroviral therapy (ART) (84% vs. 78%, OR(adj) = 1.49, 95%CI 1.20-1.85). Treatment success of 85% was achieved in HIV-positive patients who received RFB and DOT. CONCLUSION: High mortality precluded achieving 85% treatment success among HIV-positive TB patients. DOT and ART remain essential for improving success among co-infected patients everywhere.
OBJECTIVE: To review outcomes of human immunodeficiency virus (HIV) positive tuberculosis (TB) patients in New York City (NYC) to determine if the World Health Organization treatment success target of 85% was met in a setting with ready access to treatment for HIV and TB. DESIGN: Retrospective review of new TB patients diagnosed from 1995 to 2004, excluding patients with rifampin (RMP) resistance. RESULTS: Of 9198 eligible TB patients, 83% had achieved treatment success, 8% died during treatment, 4% failed, 3% defaulted and 2% were transferred from NYC. Among 6374 HIV-negative individuals, treatment success was consistently over 85%; 5% died during treatment. Among 2824 HIV-positive individuals, treatment success was 72% overall and 66% in sputum acid-fast bacilli smear-positive patients. Mortality among the HIV-positive decreased from 26% in 1995 to 14% in 2004. HIV-positive patients achieved higher treatment success if 1) they received treatment by directly observed therapy (DOT) (82% vs. 74%, OR(adj) = 1.80, 95%CI 1.44-2.26), or 2) were administered rifabutin (RFB) in the regimen, a proxy for receiving antiretroviral therapy (ART) (84% vs. 78%, OR(adj) = 1.49, 95%CI 1.20-1.85). Treatment success of 85% was achieved in HIV-positive patients who received RFB and DOT. CONCLUSION: High mortality precluded achieving 85% treatment success among HIV-positive TB patients. DOT and ART remain essential for improving success among co-infectedpatients everywhere.
Authors: Payam Nahid; Susan E Dorman; Narges Alipanah; Pennan M Barry; Jan L Brozek; Adithya Cattamanchi; Lelia H Chaisson; Richard E Chaisson; Charles L Daley; Malgosia Grzemska; Julie M Higashi; Christine S Ho; Philip C Hopewell; Salmaan A Keshavjee; Christian Lienhardt; Richard Menzies; Cynthia Merrifield; Masahiro Narita; Rick O'Brien; Charles A Peloquin; Ann Raftery; Jussi Saukkonen; H Simon Schaaf; Giovanni Sotgiu; Jeffrey R Starke; Giovanni Battista Migliori; Andrew Vernon Journal: Clin Infect Dis Date: 2016-08-10 Impact factor: 9.079
Authors: G Bushnell; N L Stennis; A M Drobnik; D C Proops; S D Ahuja; K Bornschlegel; J Fuld Journal: Epidemiol Infect Date: 2014-11-12 Impact factor: 4.434