Predictors and outcomes of Mycobacterium tuberculosis bacteremia among patients with HIV and tuberculosis co-infection enrolled in the ACTG A5221 STRIDE study.

Crump, John A

Wu, Xingye

Kendall, Michelle A

Ive, Prudence D

Kumwenda, Johnstone J

Grinsztejn, Beatriz

Jentsch, Ute

Swindells, Susan

England

2017-03-02T19:04:43Z

2017-03-02T19:04:43Z

2015-01-13

BACKGROUND: We evaluated predictors and outcomes of Mycobacterium tuberculosis bacteremia among participants undergoing baseline mycobacterial blood culture in the ACTG A5221 STRIDE study, a randomized clinical trial comparing earlier with later ART among HIV-infected patients suspected of having tuberculosis with CD4-positive T-lymphocyte counts (CD4 counts) <250 cells/mm(3). We conducted a secondary analysis comparing participants with respect to presence or absence of M. tuberculosis bacteremia. METHODS: Participants with a baseline mycobacterial blood culture were compared with respect to the presence or absence of M. tuberculosis bacteremia. Baseline predictors of M. tuberculosis bacteremia were identified and participant outcomes were compared by mycobacteremia status. RESULTS: Of 90 participants with baseline mycobacterial blood cultures, 29 (32.2%) were female, the median (IQR) age was 37 (31-45) years, CD4 count was 81 (33-131) cells/mm(3), HIV-1 RNA level was 5.39 (4.96-5.83) log10 copies/mL, and 18 (20.0%) had blood cultures positive for M. tuberculosis. In multivariable analysis, lower CD4 count (OR 0.85 per 10-cell increase, p = 0.012), hemoglobin ≤8.5 g/dL (OR 5.8, p = 0.049), and confirmed tuberculosis (OR 17.4, p = 0.001) were associated with M. tuberculosis bacteremia. There were no significant differences in survival and AIDS-free survival, occurrence of tuberculosis immune reconstitution inflammatory syndrome (IRIS), or treatment interruption or discontinuation by M. tuberculosis bacteremia status. IRIS did not differ significantly between groups despite trends toward more virologic suppression and greater CD4 count increases at week 48 in the bacteremic group. CONCLUSIONS: Among HIV-infected tuberculosis suspects, lower CD4 count, hemoglobin ≤8.5 g/dL, and the presence of microbiologically confirmed pulmonary tuberculosis were associated with increased adjusted odds of mycobacteremia. No evidence of an association between M. tuberculosis bacteremia and the increased risk of IRIS was detected. TRIAL REGISTRATION: ClinicalTrials.gov: NCT00108862 .

https://www.ncbi.nlm.nih.gov/pubmed/25582793

s12879-014-0735-5

1471-2334

https://hdl.handle.net/10161/13769

eng

Springer Science and Business Media LLC

BMC Infect Dis

10.1186/s12879-014-0735-5

Adult

Age Factors

Antiretroviral Therapy, Highly Active

Bacteremia

CD4 Lymphocyte Count

Coinfection

Female

HIV Infections

HIV-1

Humans

Male

Middle Aged

Mycobacterium tuberculosis

Sex Factors

South Africa

Survival Analysis

Tuberculosis, Pulmonary

Predictors and outcomes of Mycobacterium tuberculosis bacteremia among patients with HIV and tuberculosis co-infection enrolled in the ACTG A5221 STRIDE study.

Journal article

https://www.ncbi.nlm.nih.gov/pubmed/25582793

12

Clinical Science Departments

Duke

Medicine

Medicine, Infectious Diseases

Pathology

School of Medicine

Published online

15