Low mortality rates at two years in HIV-infected individuals undergoing systematic tuberculosis testing with rapid assays at initiation of antiretroviral treatment in Mozambique release_ceqhmksmnnft7nfsim223xm2ha

Abstract

Few studies have evaluated the mortality rate in individuals with HIV initiating antiretroviral therapy (ART), undergoing screening with combined or repeated rapid tests for tuberculosis (TB). All individuals with HIV starting ART, irrespective of presence of TB-related symptoms, received two consecutive Xpert tests plus a rapid test for detection of mycobacterial lipoarabinomannan in urine (LAM). Mortality was evaluated in Kaplan-Meier analyses using the log-rank test in univariate analyses and Cox regression models with time-dependent covariates in multivariate analyses. Among 972 individuals screened with combined tests, 98 (10.1%) tested positive for TB with Xpert, LAM, or both. At the end of the study, 780 (80.2%) had completed two years of follow up, 39 (4.0%) had deceased, and 153 (15.7%) were lost to follow up. In multivariate analyses, the factors significantly associated with mortality were missed ART (hazard ratio [HR]: 7.05, 95%CI 2.33-21.35), symptomatic (WHO-HIV stage >1) HIV disease (HR 3.31, 95%CI 1.28-8.54), and low (<200/mm3) CD4 (HR 2.72, 95%CI 1.21-6.13), with no significant effect of TB status. In the subgroup of the 98 TB-positive individuals, only missed ART (HR 4.12, 95% CI 1.03-16.46) and missed anti-TB treatment (HR 9.25, 95%CI 2.65-32.28) were significantly associated with mortality. We observed a low mortality rate among individuals with HIV undergoing systematic testing for TB at initiation of ART. After adjusting for confounders, mortality was significantly associated with missed ART, advanced disease, and missed anti-TB treatment. These findings reinforce the need to promote early diagnosis of HIV and the adoption of screening strategies for TB that prevent presentation with severe disease.
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