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Background <p>Tuberculosis is a severe disease, not only due to its lethality but also to a significant morbidity occurring in people living with HIV (PLWH). If factors associated to mortality, severe morbidity and unsuccessful treatment related to the host are well identified in PLWH, there is scarce knowledge on factors related to the disease itself such as bacillary load, extent of lung involvement and disease dissemination to other organs. We sought to assess whether tuberculosis-related factors were associated with key patient outcomes in PLWH using data from an international clinical trial.</p> Methods <p>We conducted a secondary analysis of the ANRS 12300 Reflate TB2, an international phase III open-label randomized trial that assessed different antiretroviral regimens in PLWH treated for tuberculosis. We evaluated whether bacillary load (smear positivity grade), extent of lung involvement (cavitation on chest x-ray) and disease dissemination (urine LAM positivity) were associated with mortality using Cox proportional hazard models, and to severe morbidity and unsuccessful tuberculosis treatment using logistic regressions.</p> Results <p>Of 457 participants included in this study, 90 (20.4%) had grade 2 + or 3 + smear positivity, 39 (10.8%) had cavitation on chest X-ray, and 147 (32.2%) had a positive urinary LAM. Overall, 19 (4.2%) participants died, 113 (24.7%) presented severe morbidity, and 33 (7.2%) had unsuccessful tuberculosis treatment. Factors that remained independently associated with mortality were cavitation on chest x-ray (aHR = 7.92, 95% CI, 1.74–35.94, <i>p</i> = .0073) and LAM positivity (aHR = 5.53, 95% CI, 1.09–28.06, <i>p</i> = .0389). The only factor that remained significantly associated with severe morbidity was LAM positivity (aOR = 2.04, 95% CI, 1.06–3.92, <i>p</i> = .0323). No factor remained significantly associated with unsuccessful tuberculosis treatment.</p> Conclusions <p>In PLWH with tuberculosis enrolled in a trial, tuberculosis disease characteristics related to disease severity were cavitation on chest x-ray and urine LAM positivity. Early identification of these factors could help improve the management of PLWH with tuberculosis and improve their survival.</p>

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Tuberculosis disease characteristics associated with mortality, severe morbidity and unsuccessful treatment in people living with HIV treated for tuberculosis – a secondary analysis of the ANRS 12300 Reflate TB2 trial

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  • 发表日期：

    2025年5月14日

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  • Robert Akpata,
  • Jean-Baptiste Ntakpe,
  • Eugène Messou,
  • Nathalie De Castro,
  • Corine Chazallon,
  • Isabel Timana,
  • Rodrigo Escada,
  • Sandra Wagner Cardoso,
  • Nilesh Bhatt,
  • Celso Khosa,
  • Didier Laureillard,
  • Giang Do Chau,
  • Frédéric Ello Nogbou,
  • Donald Diomande Glao,
  • Valdilea Veloso,
  • Jean-Michel Molina,
  • Beatriz Grinsztejn,
  • Marcel Zannou,
  • Serge Eholie,
  • Olivier Marcy,
  • Marie De Solere,
  • Alice Montoyo,
  • Claire Rekacewicz,
  • Alpha Diallo,
  • Xavier Anglaret,
  • Jérôme Le Carrou,
  • Aurélie Beuscart,
  • Gemma Guylène Habiyambere,
  • Sophie Karcher,
  • Rodrigo Otávio da Silva Escada,
  • Tânia Krsitic,
  • Thiago Silva Torres,
  • Ronaldo Ismerio Moreira,
  • Flávia Lessa,
  • Ana Cláudia Alves,
  • Daniel de moura Rebelo,
  • Luiz Ricardo Siqueira Camacho,
  • Sandro Nazer,
  • Soraia Santana de Moura,
  • Luana Marins,
  • Maura Lassance Gonzales,
  • Robson Pierre Nascimento da Silva,
  • Tatiane Gomes,
  • Valéria Rita Teixeira Ribeiro,
  • Ana Cristina Garcia FerreIira,
  • Brenda Hoagland,
  • Débora Faber Marra Barreto,
  • Desiree Vieira Gomes dos Santos,
  • Isabel Cristina Ferreira Tavares,
  • Lara Esteves Coelho,
  • Lucimar Santos Salgado,
  • Donald G. Diomandé,
  • Amani Anzian,
  • Joachim Gnokoro,
  • Etienne Etilé,
  • Jacqueline Amani,
  • Georgette Labibi,
  • Cecile A. Tchehy,
  • MC Kassy,
  • Antoine Toho BI,
  • Lambert Konan,
  • E. Messou,
  • Cyprien Rabe,
  • Frederick Ello,
  • Fulgence Eboumou,
  • Salimata Fanny,
  • Bonzou Amoakon,
  • Samuel Kan,
  • Robert Gbey,
  • Martin Y. Kouamé,
  • Yamissa Siloue,
  • Lehi Dano,
  • Florence Kouakou,
  • Kakou Aka,
  • Serge P. Eholié,
  • Jean-Baptiste N’takpé,
  • Suzanne Kouadio,
  • Irmine Ahyi,
  • Bertine Siloue,
  • Marcelin Irié,
  • Romuald Konan,
  • Arlette Emieme,
  • Thomas-d’Aquin Toni,
  • Fatoumata Koné,
  • Jean-Claude Kacou,
  • Hervé Menan,
  • Diane Ponscarme,
  • Miresta Previllon,
  • Constance Delaugerre,
  • Dilário Nhumaio,
  • Emelva Manhiça,
  • Arlindo Vilanculo,
  • Khalide Azam,
  • Adolfo Vubil,
  • Nádia Sitoe,
  • Alcina Zitha,
  • Jorge Ribeiro,
  • Lectícia Matsinhe,
  • Do Chau Giang,
  • Nguyen Duc Bang,
  • Nguyen Ngoc Lan,
  • Nguyen Huu Lân,
  • Dang Thi Minh Há,
  • Nguyen Thi Hong,
  • Nguyen Nhu Viet,
  • Bui Thi Kim Nhung,
  • Tran Pham Phuong Thao,
  • Pham Thu Hang,
  • Mai Thi Thu Huyen,
  • Tran Huu Loc,
  • Tran Thi Kim Quy,
  • Do Ha Thanh Trang,
  • Nguyen Thi Cao Van,
  • Mai Nguyet Thu Huyen,
  • Nguyen Thi Nuoi,
  • Cao Khanh Tung,
  • Tran Thi Thuy Tien,
  • Huynh Phuong Anh,
  • Pham Thi Quynh Anh,
  • Long Duong Van,
  • Le Thi Ngoc Bich,
  • Cong Thi Mai Luong,
  • TRAN Ton,
  • Vu Xuan Thinh,
  • Huynh Hoang Khanh Thu,
  • Luong Que Anh,
  • Do Ha Thanh Trang,
  • Delphine Rapoud,
  • Anaïs Domergue,
  • Le Quoc Khanh,
  • Dong Quynh Nhu,
  • Bui Vu Hoang Trang,
  • Dinh Phuong Thanh,
  • Tran Thi Hieu Nhi,
  • Tran Thi-Hai Ly,
  • Frederique Guiroy

摘要

Background

Tuberculosis is a severe disease, not only due to its lethality but also to a significant morbidity occurring in people living with HIV (PLWH). If factors associated to mortality, severe morbidity and unsuccessful treatment related to the host are well identified in PLWH, there is scarce knowledge on factors related to the disease itself such as bacillary load, extent of lung involvement and disease dissemination to other organs. We sought to assess whether tuberculosis-related factors were associated with key patient outcomes in PLWH using data from an international clinical trial.

Methods

We conducted a secondary analysis of the ANRS 12300 Reflate TB2, an international phase III open-label randomized trial that assessed different antiretroviral regimens in PLWH treated for tuberculosis. We evaluated whether bacillary load (smear positivity grade), extent of lung involvement (cavitation on chest x-ray) and disease dissemination (urine LAM positivity) were associated with mortality using Cox proportional hazard models, and to severe morbidity and unsuccessful tuberculosis treatment using logistic regressions.

Results

Of 457 participants included in this study, 90 (20.4%) had grade 2 + or 3 + smear positivity, 39 (10.8%) had cavitation on chest X-ray, and 147 (32.2%) had a positive urinary LAM. Overall, 19 (4.2%) participants died, 113 (24.7%) presented severe morbidity, and 33 (7.2%) had unsuccessful tuberculosis treatment. Factors that remained independently associated with mortality were cavitation on chest x-ray (aHR = 7.92, 95% CI, 1.74–35.94, p = .0073) and LAM positivity (aHR = 5.53, 95% CI, 1.09–28.06, p = .0389). The only factor that remained significantly associated with severe morbidity was LAM positivity (aOR = 2.04, 95% CI, 1.06–3.92, p = .0323). No factor remained significantly associated with unsuccessful tuberculosis treatment.

Conclusions

In PLWH with tuberculosis enrolled in a trial, tuberculosis disease characteristics related to disease severity were cavitation on chest x-ray and urine LAM positivity. Early identification of these factors could help improve the management of PLWH with tuberculosis and improve their survival.