Differences in response to antiretroviral therapy in HIV-positive patients being treated for tuberculosis in Eastern Europe, Western Europe and Latin America

Yanink Caro-Vega; Anna Schultze; Anne Marie W Efsen; Frank A Post; Alexander Panteleev; Aliaksandr Skrahin; Jose M Miro; Enrico Girardi; Daria N Podlekareva; Jens D Lundgren; Juan Sierra-Madero; Javier Toibaro; Jaime Andrade-Villanueva; Simona Tetradov; Jan Fehr; Joan Caylà; Marcelo H Losso; Robert F Miller; Amanda Mocroft; Ole Kirk; Brenda Crabtree-Ramírez

doi:10.1186/s12879-018-3077-x

Differences in response to antiretroviral therapy in HIV-positive patients being treated for tuberculosis in Eastern Europe, Western Europe and Latin America

Yanink Caro-Vega, Anna Schultze, Anne Marie W Efsen, Frank A Post, Alexander Panteleev, Aliaksandr Skrahin, Jose M Miro, Enrico Girardi, Daria N Podlekareva, Jens D Lundgren, Juan Sierra-Madero, Javier Toibaro, Jaime Andrade-Villanueva, Simona Tetradov, Jan Fehr, Joan Caylà, Marcelo H Losso, Robert F Miller, Amanda Mocroft, Ole KirkBrenda Crabtree-Ramírez

Department of Clinical Medicine

2 Citations (Scopus)

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Abstract

BACKGROUND: Efavirenz-based antiretroviral therapy (ART) regimens are preferred for treatment of adult HIV-positive patients co-infected with tuberculosis (HIV/TB). Few studies have compared outcomes among HIV/TB patients treated with efavirenz or non-efavirenz containing regimens.

METHODS: HIV-positive patients aged ≥16 years with a diagnosis of tuberculosis recruited to the TB:HIV study between Jan 1, 2011, and Dec 31, 2013 in 19 countries in Eastern Europe (EE), Western Europe (WE), and Latin America (LA) who received ART concomitantly with TB treatment were included. Patients either received efavirenz-containing ART starting between 15 days prior to, during, or within 90 days after starting tuberculosis treatment, (efavirenz group), or other ART regimens (non-efavirenz group). Patients who started ART more than 90 days after initiation of TB treatment, or who experienced ART interruption of more than 15 days during TB treatment were excluded. We describe rates and factors associated with death, virological suppression, and loss to follow up at 12 months using univariate, multivariate Cox, and marginal structural models to compare the two groups of patients.

RESULTS: Of 965 patients (647 receiving efavirenz-containing ART, and 318 a non-efavirenz regimen) 50% were from EE, 28% from WE, and 22% from LA. Among those not receiving efavirenz-containing ART, regimens mainly contained a ritonavir-boosted protease inhibitor (57%), or raltegravir (22%). At 12 months 1.4% of patients in WE had died, compared to 20% in EE: rates of virological suppression ranged from 21% in EE to 61% in WE. After adjusting for potential confounders, rates of death (adjusted Hazard Ratio; aHR, 95%CI: 1.13, 0.72-1.78), virological suppression (aHR, 95%CI: 0.97, 0.76-1.22), and loss to follow up (aHR, 95%CI: 1.17, 0.81-1.67), were similar in patients treated with efavirenz and non-efavirenz containing ART regimens.

CONCLUSION: In this large, prospective cohort, the response to ART varied significantly across geographical regions, whereas the ART regimen (efavirenz or non-efavirenz containing) did not impact on the proportion of patients who were virologically-suppressed, lost to follow up or dead at 12 months.

Original language	English
Article number	191
Journal	BMC Infectious Diseases
Volume	18
Issue number	1
Number of pages	11
ISSN	1471-2334
DOIs	https://doi.org/10.1186/s12879-018-3077-x
Publication status	Published - 23 Apr 2018

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Differences in response to antiretroviral therapy in HIV-positive patients being treated for tuberculosis in Eastern Europe, Western Europe and Latin AmericaFinal published version, 473 KBLicence: CC BY

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Caro-Vega, Y., Schultze, A., W Efsen, A. M., Post, F. A., Panteleev, A., Skrahin, A., Miro, J. M., Girardi, E., Podlekareva, D. N., Lundgren, J. D., Sierra-Madero, J., Toibaro, J., Andrade-Villanueva, J., Tetradov, S., Fehr, J., Caylà, J., Losso, M. H., Miller, R. F., Mocroft, A., ... Crabtree-Ramírez, B. (2018). Differences in response to antiretroviral therapy in HIV-positive patients being treated for tuberculosis in Eastern Europe, Western Europe and Latin America. BMC Infectious Diseases, 18(1), Article 191. https://doi.org/10.1186/s12879-018-3077-x

Differences in response to antiretroviral therapy in HIV-positive patients being treated for tuberculosis in Eastern Europe, Western Europe and Latin America. / Caro-Vega, Yanink; Schultze, Anna; W Efsen, Anne Marie et al.
In: BMC Infectious Diseases, Vol. 18, No. 1, 191, 23.04.2018.

Research output: Contribution to journal › Journal article › Research › peer-review

Caro-Vega, Y, Schultze, A, W Efsen, AM, Post, FA, Panteleev, A, Skrahin, A, Miro, JM, Girardi, E, Podlekareva, DN, Lundgren, JD, Sierra-Madero, J, Toibaro, J, Andrade-Villanueva, J, Tetradov, S, Fehr, J, Caylà, J, Losso, MH, Miller, RF, Mocroft, A, Kirk, O & Crabtree-Ramírez, B 2018, 'Differences in response to antiretroviral therapy in HIV-positive patients being treated for tuberculosis in Eastern Europe, Western Europe and Latin America', BMC Infectious Diseases, vol. 18, no. 1, 191. https://doi.org/10.1186/s12879-018-3077-x

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title = "Differences in response to antiretroviral therapy in HIV-positive patients being treated for tuberculosis in Eastern Europe, Western Europe and Latin America",

abstract = "BACKGROUND: Efavirenz-based antiretroviral therapy (ART) regimens are preferred for treatment of adult HIV-positive patients co-infected with tuberculosis (HIV/TB). Few studies have compared outcomes among HIV/TB patients treated with efavirenz or non-efavirenz containing regimens.METHODS: HIV-positive patients aged ≥16 years with a diagnosis of tuberculosis recruited to the TB:HIV study between Jan 1, 2011, and Dec 31, 2013 in 19 countries in Eastern Europe (EE), Western Europe (WE), and Latin America (LA) who received ART concomitantly with TB treatment were included. Patients either received efavirenz-containing ART starting between 15 days prior to, during, or within 90 days after starting tuberculosis treatment, (efavirenz group), or other ART regimens (non-efavirenz group). Patients who started ART more than 90 days after initiation of TB treatment, or who experienced ART interruption of more than 15 days during TB treatment were excluded. We describe rates and factors associated with death, virological suppression, and loss to follow up at 12 months using univariate, multivariate Cox, and marginal structural models to compare the two groups of patients.RESULTS: Of 965 patients (647 receiving efavirenz-containing ART, and 318 a non-efavirenz regimen) 50% were from EE, 28% from WE, and 22% from LA. Among those not receiving efavirenz-containing ART, regimens mainly contained a ritonavir-boosted protease inhibitor (57%), or raltegravir (22%). At 12 months 1.4% of patients in WE had died, compared to 20% in EE: rates of virological suppression ranged from 21% in EE to 61% in WE. After adjusting for potential confounders, rates of death (adjusted Hazard Ratio; aHR, 95%CI: 1.13, 0.72-1.78), virological suppression (aHR, 95%CI: 0.97, 0.76-1.22), and loss to follow up (aHR, 95%CI: 1.17, 0.81-1.67), were similar in patients treated with efavirenz and non-efavirenz containing ART regimens.CONCLUSION: In this large, prospective cohort, the response to ART varied significantly across geographical regions, whereas the ART regimen (efavirenz or non-efavirenz containing) did not impact on the proportion of patients who were virologically-suppressed, lost to follow up or dead at 12 months.",

author = "Yanink Caro-Vega and Anna Schultze and {W Efsen}, {Anne Marie} and Post, {Frank A} and Alexander Panteleev and Aliaksandr Skrahin and Miro, {Jose M} and Enrico Girardi and Podlekareva, {Daria N} and Lundgren, {Jens D} and Juan Sierra-Madero and Javier Toibaro and Jaime Andrade-Villanueva and Simona Tetradov and Jan Fehr and Joan Cayl{\`a} and Losso, {Marcelo H} and Miller, {Robert F} and Amanda Mocroft and Ole Kirk and Brenda Crabtree-Ram{\'i}rez",

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doi = "10.1186/s12879-018-3077-x",

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T1 - Differences in response to antiretroviral therapy in HIV-positive patients being treated for tuberculosis in Eastern Europe, Western Europe and Latin America

AU - Caro-Vega, Yanink

AU - Schultze, Anna

AU - W Efsen, Anne Marie

AU - Post, Frank A

AU - Panteleev, Alexander

AU - Skrahin, Aliaksandr

AU - Miro, Jose M

AU - Girardi, Enrico

AU - Podlekareva, Daria N

AU - Lundgren, Jens D

AU - Sierra-Madero, Juan

AU - Toibaro, Javier

AU - Andrade-Villanueva, Jaime

AU - Tetradov, Simona

AU - Fehr, Jan

AU - Caylà, Joan

AU - Losso, Marcelo H

AU - Miller, Robert F

AU - Mocroft, Amanda

AU - Kirk, Ole

AU - Crabtree-Ramírez, Brenda

PY - 2018/4/23

Y1 - 2018/4/23

N2 - BACKGROUND: Efavirenz-based antiretroviral therapy (ART) regimens are preferred for treatment of adult HIV-positive patients co-infected with tuberculosis (HIV/TB). Few studies have compared outcomes among HIV/TB patients treated with efavirenz or non-efavirenz containing regimens.METHODS: HIV-positive patients aged ≥16 years with a diagnosis of tuberculosis recruited to the TB:HIV study between Jan 1, 2011, and Dec 31, 2013 in 19 countries in Eastern Europe (EE), Western Europe (WE), and Latin America (LA) who received ART concomitantly with TB treatment were included. Patients either received efavirenz-containing ART starting between 15 days prior to, during, or within 90 days after starting tuberculosis treatment, (efavirenz group), or other ART regimens (non-efavirenz group). Patients who started ART more than 90 days after initiation of TB treatment, or who experienced ART interruption of more than 15 days during TB treatment were excluded. We describe rates and factors associated with death, virological suppression, and loss to follow up at 12 months using univariate, multivariate Cox, and marginal structural models to compare the two groups of patients.RESULTS: Of 965 patients (647 receiving efavirenz-containing ART, and 318 a non-efavirenz regimen) 50% were from EE, 28% from WE, and 22% from LA. Among those not receiving efavirenz-containing ART, regimens mainly contained a ritonavir-boosted protease inhibitor (57%), or raltegravir (22%). At 12 months 1.4% of patients in WE had died, compared to 20% in EE: rates of virological suppression ranged from 21% in EE to 61% in WE. After adjusting for potential confounders, rates of death (adjusted Hazard Ratio; aHR, 95%CI: 1.13, 0.72-1.78), virological suppression (aHR, 95%CI: 0.97, 0.76-1.22), and loss to follow up (aHR, 95%CI: 1.17, 0.81-1.67), were similar in patients treated with efavirenz and non-efavirenz containing ART regimens.CONCLUSION: In this large, prospective cohort, the response to ART varied significantly across geographical regions, whereas the ART regimen (efavirenz or non-efavirenz containing) did not impact on the proportion of patients who were virologically-suppressed, lost to follow up or dead at 12 months.

AB - BACKGROUND: Efavirenz-based antiretroviral therapy (ART) regimens are preferred for treatment of adult HIV-positive patients co-infected with tuberculosis (HIV/TB). Few studies have compared outcomes among HIV/TB patients treated with efavirenz or non-efavirenz containing regimens.METHODS: HIV-positive patients aged ≥16 years with a diagnosis of tuberculosis recruited to the TB:HIV study between Jan 1, 2011, and Dec 31, 2013 in 19 countries in Eastern Europe (EE), Western Europe (WE), and Latin America (LA) who received ART concomitantly with TB treatment were included. Patients either received efavirenz-containing ART starting between 15 days prior to, during, or within 90 days after starting tuberculosis treatment, (efavirenz group), or other ART regimens (non-efavirenz group). Patients who started ART more than 90 days after initiation of TB treatment, or who experienced ART interruption of more than 15 days during TB treatment were excluded. We describe rates and factors associated with death, virological suppression, and loss to follow up at 12 months using univariate, multivariate Cox, and marginal structural models to compare the two groups of patients.RESULTS: Of 965 patients (647 receiving efavirenz-containing ART, and 318 a non-efavirenz regimen) 50% were from EE, 28% from WE, and 22% from LA. Among those not receiving efavirenz-containing ART, regimens mainly contained a ritonavir-boosted protease inhibitor (57%), or raltegravir (22%). At 12 months 1.4% of patients in WE had died, compared to 20% in EE: rates of virological suppression ranged from 21% in EE to 61% in WE. After adjusting for potential confounders, rates of death (adjusted Hazard Ratio; aHR, 95%CI: 1.13, 0.72-1.78), virological suppression (aHR, 95%CI: 0.97, 0.76-1.22), and loss to follow up (aHR, 95%CI: 1.17, 0.81-1.67), were similar in patients treated with efavirenz and non-efavirenz containing ART regimens.CONCLUSION: In this large, prospective cohort, the response to ART varied significantly across geographical regions, whereas the ART regimen (efavirenz or non-efavirenz containing) did not impact on the proportion of patients who were virologically-suppressed, lost to follow up or dead at 12 months.

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DO - 10.1186/s12879-018-3077-x

M3 - Journal article

C2 - 29685113

SN - 1471-2334

VL - 18

JO - BMC Infectious Diseases

JF - BMC Infectious Diseases

IS - 1

M1 - 191

ER -

Differences in response to antiretroviral therapy in HIV-positive patients being treated for tuberculosis in Eastern Europe, Western Europe and Latin America

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