@article{Demitto2019,
abstract = {Background The implementation of antiretroviral (ARV) therapy caused a significant decrease in HIV-associated mortality worldwide. Nevertheless, mortality is still high among people living with HIV/AIDS and tuberculosis (TB). ARV-na{\"{i}}ve HIV patients coinfected with tuberculosis (TB) have more options to treat both diseases concomitantly. Nevertheless, some TB-HIV patients undertaking ARVs (ARV-experienced) are already failing the first line efavirenz-based regimen and seem to display different response to second line ARV therapy and exhibit other predictors of mortality. Methods We performed a retrospective cohort study including 273 patients diagnosed with TB-HIV and treated at a referral center in Rio de Janeiro, Brazil, between 2008 and 2016. Multivariate analysis and Cox regression models were used to evaluate the effectiveness of ARV therapy regimens (viral load [VL] {\textless}80 copies from the 4th to 10th months after TB therapy introduction) and to identify predictors of early mortality (100 days after TB therapy initiation) considering ARV-na{\"{i}}ve and ARV-experienced patients adjusting for sociodemographic, clinical and therapeutic covariates. Findings Survival analysis included 273 patients, out of whom 154 (56.4{\%}) were ARV-na{\"{i}}ve and 119 (43.6{\%}) were ARV-experienced. Seven deaths occurred within 6 months of anti-TB treatment, 4 in ARV-na{\"{i}}ve and 3 in ARV-experienced patients. Multivariate analysis revealed that in ARV-na{\"{i}}ve patients, the chance of death was substantially higher in patients who developed immune reconstitution inflammatory syndrome during the study follow up (HR = 40.6, p{\textless}0.01). For ARV-experienced patients, similar analyses failed to identify factors significantly associated with mortality. Variables independently associated with treatment failure for the ARV-na{\"{i}}ve group were previous TB (adjusted OR [aOR] = 6.1 p = 0.03) and alcohol abuse (aOR = 3.7 p = 0.01). For ARV-experienced patients, a ritonavir boosted. Protease Inhibitor-based regimen resulted in a 2.6 times higher risk of treatment failure compared to the use of efavirenz based ARV regimens (p = 0.03) and High baseline HIV VL (p = 0.03) were predictors of treatment failure. Conclusions Risk factors for mortality and ARV failure were different for ARV-na{\"{i}}ve and ARV-experienced patients. The latter patient group should be targeted for trials with less toxic and rifampicin-compatible drugs to improve TB-HIV treatment outcomes and prevent death.},
author = {Demitto, Fernanda O and Schmaltz, Carolina A S and Sant'Anna, Fl{\'{a}}via M and Arriaga, Mar{\'{i}}a B and Andrade, Bruno B and Rolla, Valeria C},
doi = {10.1371/journal.pone.0217014},
editor = {Nicastri, Emanuele},
file = {:C$\backslash$:/Users/01462563/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Demitto et al. - 2019 - Predictors of early mortality and effectiveness of antiretroviral therapy in TB-HIV patients from Brazil.pdf:pdf},
journal = {PLOS ONE},
keywords = {OA,fund{\_}not{\_}ack,original},
mendeley-tags = {OA,fund{\_}not{\_}ack,original},
month = {jun},
number = {6},
pages = {e0217014},
pmid = {31170171},
publisher = {Public Library of Science},
title = {{Predictors of early mortality and effectiveness of antiretroviral therapy in TB-HIV patients from Brazil}},
url = {http://dx.plos.org/10.1371/journal.pone.0217014},
volume = {14},
year = {2019}
}

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Methods We performed a retrospective cohort study including 273 patients diagnosed with TB-HIV and treated at a referral center in Rio de Janeiro, Brazil, between 2008 and 2016. Multivariate analysis and Cox regression models were used to evaluate the effectiveness of ARV therapy regimens (viral load [VL] \\textless80 copies from the 4th to 10th months after TB therapy introduction) and to identify predictors of early mortality (100 days after TB therapy initiation) considering ARV-naïve and ARV-experienced patients adjusting for sociodemographic, clinical and therapeutic covariates. Findings Survival analysis included 273 patients, out of whom 154 (56.4%) were ARV-naïve and 119 (43.6%) were ARV-experienced. Seven deaths occurred within 6 months of anti-TB treatment, 4 in ARV-naïve and 3 in ARV-experienced patients. Multivariate analysis revealed that in ARV-naïve patients, the chance of death was substantially higher in patients who developed immune reconstitution inflammatory syndrome during the study follow up (HR = 40.6, p\\textless0.01). For ARV-experienced patients, similar analyses failed to identify factors significantly associated with mortality. Variables independently associated with treatment failure for the ARV-naïve group were previous TB (adjusted OR [aOR] = 6.1 p = 0.03) and alcohol abuse (aOR = 3.7 p = 0.01). For ARV-experienced patients, a ritonavir boosted. Protease Inhibitor-based regimen resulted in a 2.6 times higher risk of treatment failure compared to the use of efavirenz based ARV regimens (p = 0.03) and High baseline HIV VL (p = 0.03) were predictors of treatment failure. Conclusions Risk factors for mortality and ARV failure were different for ARV-naïve and ARV-experienced patients. The latter patient group should be targeted for trials with less toxic and rifampicin-compatible drugs to improve TB-HIV treatment outcomes and prevent death.","author":[{"propositions":[],"lastnames":["Demitto"],"firstnames":["Fernanda","O"],"suffixes":[]},{"propositions":[],"lastnames":["Schmaltz"],"firstnames":["Carolina","A","S"],"suffixes":[]},{"propositions":[],"lastnames":["Sant'Anna"],"firstnames":["Flávia","M"],"suffixes":[]},{"propositions":[],"lastnames":["Arriaga"],"firstnames":["María","B"],"suffixes":[]},{"propositions":[],"lastnames":["Andrade"],"firstnames":["Bruno","B"],"suffixes":[]},{"propositions":[],"lastnames":["Rolla"],"firstnames":["Valeria","C"],"suffixes":[]}],"doi":"10.1371/journal.pone.0217014","editor":[{"propositions":[],"lastnames":["Nicastri"],"firstnames":["Emanuele"],"suffixes":[]}],"file":":C$\\$:/Users/01462563/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Demitto et al. - 2019 - Predictors of early mortality and effectiveness of antiretroviral therapy in TB-HIV patients from Brazil.pdf:pdf","journal":"PLOS ONE","keywords":"OA,fund_not_ack,original","mendeley-tags":"OA,fund_not_ack,original","month":"jun","number":"6","pages":"e0217014","pmid":"31170171","publisher":"Public Library of Science","title":"Predictors of early mortality and effectiveness of antiretroviral therapy in TB-HIV patients from Brazil","url":"http://dx.plos.org/10.1371/journal.pone.0217014","volume":"14","year":"2019","bibtex":"@article{Demitto2019,\r\nabstract = {Background The implementation of antiretroviral (ARV) therapy caused a significant decrease in HIV-associated mortality worldwide. Nevertheless, mortality is still high among people living with HIV/AIDS and tuberculosis (TB). ARV-na{\\\"{i}}ve HIV patients coinfected with tuberculosis (TB) have more options to treat both diseases concomitantly. Nevertheless, some TB-HIV patients undertaking ARVs (ARV-experienced) are already failing the first line efavirenz-based regimen and seem to display different response to second line ARV therapy and exhibit other predictors of mortality. Methods We performed a retrospective cohort study including 273 patients diagnosed with TB-HIV and treated at a referral center in Rio de Janeiro, Brazil, between 2008 and 2016. Multivariate analysis and Cox regression models were used to evaluate the effectiveness of ARV therapy regimens (viral load [VL] {\\textless}80 copies from the 4th to 10th months after TB therapy introduction) and to identify predictors of early mortality (100 days after TB therapy initiation) considering ARV-na{\\\"{i}}ve and ARV-experienced patients adjusting for sociodemographic, clinical and therapeutic covariates. Findings Survival analysis included 273 patients, out of whom 154 (56.4{\\%}) were ARV-na{\\\"{i}}ve and 119 (43.6{\\%}) were ARV-experienced. Seven deaths occurred within 6 months of anti-TB treatment, 4 in ARV-na{\\\"{i}}ve and 3 in ARV-experienced patients. Multivariate analysis revealed that in ARV-na{\\\"{i}}ve patients, the chance of death was substantially higher in patients who developed immune reconstitution inflammatory syndrome during the study follow up (HR = 40.6, p{\\textless}0.01). For ARV-experienced patients, similar analyses failed to identify factors significantly associated with mortality. Variables independently associated with treatment failure for the ARV-na{\\\"{i}}ve group were previous TB (adjusted OR [aOR] = 6.1 p = 0.03) and alcohol abuse (aOR = 3.7 p = 0.01). For ARV-experienced patients, a ritonavir boosted. Protease Inhibitor-based regimen resulted in a 2.6 times higher risk of treatment failure compared to the use of efavirenz based ARV regimens (p = 0.03) and High baseline HIV VL (p = 0.03) were predictors of treatment failure. Conclusions Risk factors for mortality and ARV failure were different for ARV-na{\\\"{i}}ve and ARV-experienced patients. The latter patient group should be targeted for trials with less toxic and rifampicin-compatible drugs to improve TB-HIV treatment outcomes and prevent death.},\r\nauthor = {Demitto, Fernanda O and Schmaltz, Carolina A S and Sant'Anna, Fl{\\'{a}}via M and Arriaga, Mar{\\'{i}}a B and Andrade, Bruno B and Rolla, Valeria C},\r\ndoi = {10.1371/journal.pone.0217014},\r\neditor = {Nicastri, Emanuele},\r\nfile = {:C$\\backslash$:/Users/01462563/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Demitto et al. - 2019 - Predictors of early mortality and effectiveness of antiretroviral therapy in TB-HIV patients from Brazil.pdf:pdf},\r\njournal = {PLOS ONE},\r\nkeywords = {OA,fund{\\_}not{\\_}ack,original},\r\nmendeley-tags = {OA,fund{\\_}not{\\_}ack,original},\r\nmonth = {jun},\r\nnumber = {6},\r\npages = {e0217014},\r\npmid = {31170171},\r\npublisher = {Public Library of Science},\r\ntitle = {{Predictors of early mortality and effectiveness of antiretroviral therapy in TB-HIV patients from Brazil}},\r\nurl = {http://dx.plos.org/10.1371/journal.pone.0217014},\r\nvolume = {14},\r\nyear = {2019}\r\n}\r\n","author_short":["Demitto, F. 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