CROI 2015 Program and Abstracts

Abstract Listing

Poster Abstracts

Conclusions: This econometric analysis confirms the assumed beneficial impact of between ART scale up on subsequent reductions in population-level TB mortality. However, the estimated effect size was smaller than typically assumed in global impact models. 833 Culture-Negative TB Is AssociatedWith Increased Mortality in HIV-Infected Persons Timothy Sterling 1 ; Cathy Jenkins 1 ; Karu Jayathilake 1 ; Eduardo Gotuzzo 2 ;ValdileaVeloso 3 ; Claudia P. Cortes 4 ; Denis Padgett 5 ; Brenda Crabtree-Ramirez 6 ; Bryan E. Shepherd 1 ; Catherine McGowan 1 CCASAnet 1 Vanderbilt University, Nashville, TN, US; 2 Universidad Peruana Cayetano Heredia, Lima, Peru; 3 Instituto Pequisa Evandro Chagas, Rio de Janeiro, Brazil; 4 University of Chile, Santiago, Chile; 5 Instituto Hondureno de Seguruidad Social, Tegucigalpa, Honduras; 6 Instituto Nacional de Ciencias Medicas y Nutricion, Mexico City, Mexico Background: Culture-negative TB comprises 20% of TB cases in settings where TB cultures are routinely performed. In resource-limited settings, cultures are obtained less frequently, and the proportion of culture-negative TB is often much higher. Although acid fast bacillus (AFB) smear-negative TB is associated with increased mortality in HIV+ persons, there are few data on mortality risk of culture-negative TB. Methods: We performed an observational cohort study of HIV+ adults treated for TB with standard therapy (2-month initiation phase of isoniazid, rifampin, pyrazinamide +/- ethambutol + continuation phase of isoniazid + rifampin) at or after their first HIV clinic visit. Persons were excluded if date of TB treatment relative to HAART initiation was unknown. Patients were enrolled in 2000-2013 from Brazil, Peru, Argentina, Chile, Honduras, and Mexico. Kaplan-Meier curves and Cox proportional hazards models of time from TB diagnosis to death stratified by study site were fit. For the Cox model, missing data were multiply imputed. Results: 635 TB patients met inclusion criteria, of whom 535 had known AFB smear status (265 (50%) smear-negative) and 428 had known culture status (137 (32%) culture- negative). Median age was 36 years; 76%were male, 71% had any pulmonary TB, 56% had any extrapulmonary TB. Median CD4 count at TB diagnosis was 107 (IQR: 41-235) and 526 (83%) received concurrent HAART and TB treatment. Of the 635 patients, 139 (22%) died: 36/137 (26%) culture-negative vs. 47/291 (16%) culture-positive. The Kaplan-Meier curve of time to death by culture status is in the Figure. There was no significant difference in time to death according to AFB smear status (P=0.64). In a multivariable Cox model of all 635 patients adjusted for age, sex, site of TB disease, CD4 count, and timing of HAART initiation relative to TB treatment, persons who were culture-negative had a significantly increased risk of death (HR=1.61; 95% CI: 1.09,2.38; P=0.02). There were 12 episodes of TB recurrence occurring >180 days after initiation of TB treatment; recurrence occurred more frequently in culture-negative compared to culture-positive persons (log-rank P=0.05).

Poster Abstracts

505

CROI 2015