CROI 2016 Abstract eBook

Abstract Listing

Poster Abstracts

743

High Mortality Rates in HIV-Infected TB: Suspects Who Rule Out for TB Yukari C. Manabe 1 ; RachelW. Kubiak 2 ; Lydia Nakiyingi 3 ; Henry Ssekitoleko 3 ; Sandra Armakovitch 4 ; David Hom 4 ; Moses L. Joloba 5 ; Jerrold Ellner 4 ; Susan Dorman 6 ; for theTuberculosis Clinical Diagnostic Research Consortium 1 Johns Hopkins Univ, Baltimore, MD, USA; 2 Univ of Washington, Seattle, WA, USA; 3 Infectious Diseases Inst, Makerere Univ, Kampala, Uganda; 4 Boston Med Cntr, Boston, MA, USA; 5 Makerere Univ, Kampala, Uganda; 6 Johns Hopkins Univ Sch of Med, Baltimore, MD, USA Background: One-third of the 1.1 million TB-HIV co-infected individuals worldwide died in 2013; 78% of the TB-HIV infected live in sub-Saharan Africa (SSA). Increasing proportions of HIV-infected individuals were tested for TB and started on ART which decreased incidence rates of active TB and death. Due to limited diagnostics for other causes of fever and cough, presumptive TB cases who rule-out for TB are often treated empirically for TB and other bacterial pneumonias. We sought to describe the outcomes in this group of patients. Methods: Presumptive TB patients enrolled in 3 TB diagnostic accuracy studies from 2011-2014 were followed for 6 months. TB cases were defined as patients in whom M. tuberculosis was cultured from any specimen (sputum or blood), sputum smear microscopy was positive, or if the patient was started on anti-TB treatment with subsequent documented clinical improvement within 2 months of enrollment, diagnosis of active TB within 2 months of enrollment by a non-study clinician. All others were considered not to have TB (‘not TB) for this analysis. We used chi-square and Wilcoxon-Mann-Whitney tests on categorical and continuous variables, respectively. Results: 946 presumptive TB patients were enrolled; 2 with indeterminate HIV status were excluded and 804 (85%) were HIV(+). 345/804 (43%) of the HIV(+) and 44/140 (31.4%) of the HIV(-) patients had TB, respectively. Of the HIV(+) patients, 78.4%were hospitalized. Similar proportions of the TB-HIV patients and the ‘not TB’ HIV patients died after 6 months of follow-up (26.4% vs 26.6%), despite a higher proportion of the ‘’not TB’ patients already on ART ( P =0.0016) and with a higher median CD4 T cell count (59 vs 114 cells/ µL, P <0.001). Kaplan-Meier curves shown in Figure. Conclusions: Similarly high proportions (26.4 and 26.7%) of TB and ‘not TB’ patients died among HIV(+) presumptive TB patients. Improving diagnostics for TB and other causes of acute febrile respiratory disease in HIV(+) patients are urgently needed to identify reversible causes of death to improve outcomes.

Poster Abstracts

744 Mortality in HIV+Men andWomen Investigated for TB at Ethiopian Health Centers Anton Reepalu 1 ;TayeT. Balcha 1 ; Sten Skogmar 1 ; Nuray Güner 2 ; Per Björkman 1 1 Lund Univ, Malmö, Sweden; 2 Lund Univ, Lund, Sweden

Background: Despite increased access to antiretroviral treatment (ART) in low-income countries HIV-related mortality is high, especially in the first months following ART initiation. We have evaluated the impact of concomitant TB on early mortality and assessed gender-specific predictors of mortality in a cohort of Ethiopian adults subjected to intensified case finding for TB before starting ART. Methods: Prospectively recruited ART-eligible (CD4 <350 and/or WHO stage IV) adults (n=812, 58.6% female) at five Ethiopian health centers were followed for 6 months. All participants were investigated for active TB at study inclusion by sputum culture, Xpert MTB/RIF, and smear microscopy (158/812 (19.5%) were diagnosed with TB, see figure 1). Primary outcome was all-cause mortality. Multivariate Cox models were used to identify predictors of mortality. Results: In total, 37/812 (4.6%) died, among whom 12 (32.4%) had TB. Among TB cases, 8 (66.7%) died before ART start and 4 (33.3%) died after starting ART. For non-TB cases, 10 (40.0%) died before and 15 (60.0%) after ART start. Karnofsky performance score (KPS) and mid-upper arm circumference (MUAC) were associated with mortality in the whole population. However, the associations were different in men and women. In men, only MUAC remained independently associated with mortality, adjusted hazard ratio (aHR) 0.71 (95% CI 0.57-0.88) per centimeter increase. In women KPS <80%was associated with mortality, aHR 10.95 (95% CI 2.33-51.49), as well as presence of cough, aHR 3.98 (95% CI 1.10- 14.36). Cough was also associated with mortality for TB cases, aHR 8.30 (95% CI 1.06-65.14), but not for non-TB cases.

309

CROI 2016