Ficant other comorbidity necessitating investigation and treatment.DefinitionsTuberculosis was diagnosed on the basis of smear or culture positivity. Where this was negative or unavailable, diagnosis was in line with WHO guidelines for diagnosis of smear negative or extrapurchase AN 3199 pulmonary tuberculosis in HIV-1 infected persons. [11] TBIRIS was diagnosed according to the International Network for the Study of HIV-associated IRIS (INSHI) case definitions. [12] Hospital acquired infection (HAI) was defined as an infection acquired after 48 hours of hospital 11089-65-9 web admission that was not clinically apparent at the time of the patient’s hospital admission. When organisms were cultured in the absence of an inflammatory response, the isolate was regarded as a colonising microorganism, and not classified as a HAI. [13].Study Population and EligibilityEligible patients were adults ( 18 years), hospitalised at BCH with confirmed HIV infection and a diagnosis of pulmonary (PTB) or extrapulmonary tuberculosis (EPTB), not on ART, who fulfilled national criteria for starting ART at the time of the study; CD4 count ,200 cells/mm3 or WHO Stage 4 defining illness until 31 March 2010, following which guidelines changed to include all patients with HIV-TB and CD4 count #350 cells/mm3. Exclusion criteria included patients with known rifampicin-resistant tuberculosis and those unable to provide informed consent. First episodes of tuberculosis were treated as per national policy with standard fixed dose combination tablets composed of rifampicin (R), isoniazid (H), pyrazinamide (Z), and ethambutol (E) for the 2-month intensive phase followed by RH for the 4month continuation phase. For retreatment tuberculosis, RHZE was given for 3 months with 40-doses of streptomycin followed by RHE for 5 months. Prior to 1st April 2010, first-line ART comprised stavudine (d4T), lamivudine (3TC) and efavirenz as the preferred non-nucleoside reverse transcriptase inhibitor (NNRTI) in patients on concurrent TB therapy. In April 2010 new national guidelines were introduced with tenofovir (TdF) replacing d4T. Unless contraindicated, all patients received cotrimoxazole 960 mg daily as prophylaxis, and pyridoxine 25?0 mg daily during tuberculosis treatment as well as subcutaneous unfractionated heparin (5000 IU subcutaneously 12 hrly) for deep vein thrombosis prophylaxis if bedbound.EthicsThe study was approved by the University of Cape Town’s Faculty of Health Sciences Research Ethics Committee (HREC No: 049/2009) and the Provincial Research Committee of the Department of Health, Western Cape. All participants signed written informed consent.Statistical AnalysisData were analysed using Stata version 12.0 (Stata Corporation, USA). Measures were described 23977191 with medians and interquartile ranges (IQR) or proportions. We used chi-square tests (replaced by exact tests for sparse data) to compare proportions, rank-sum tests to compare medians, and t-tests to compare mean values between groups. Kaplan-Meier methods were used to describe the survival of patients over time.Results Patient CharacteristicsA total of 130 participants were screened for enrollment (figure 1), 112 of whom met inclusion criteria and started ART in hospital. Baseline characteristics are shown in table 1. The cohort was characterised by advanced immunosuppression with WHO stage 4 disease in the majority, very low median CD4 cell count, high baseline HIV viral load and 81 were bed-bound. Approximately two thirds had disseminated.Ficant other comorbidity necessitating investigation and treatment.DefinitionsTuberculosis was diagnosed on the basis of smear or culture positivity. Where this was negative or unavailable, diagnosis was in line with WHO guidelines for diagnosis of smear negative or extrapulmonary tuberculosis in HIV-1 infected persons. [11] TBIRIS was diagnosed according to the International Network for the Study of HIV-associated IRIS (INSHI) case definitions. [12] Hospital acquired infection (HAI) was defined as an infection acquired after 48 hours of hospital admission that was not clinically apparent at the time of the patient’s hospital admission. When organisms were cultured in the absence of an inflammatory response, the isolate was regarded as a colonising microorganism, and not classified as a HAI. [13].Study Population and EligibilityEligible patients were adults ( 18 years), hospitalised at BCH with confirmed HIV infection and a diagnosis of pulmonary (PTB) or extrapulmonary tuberculosis (EPTB), not on ART, who fulfilled national criteria for starting ART at the time of the study; CD4 count ,200 cells/mm3 or WHO Stage 4 defining illness until 31 March 2010, following which guidelines changed to include all patients with HIV-TB and CD4 count #350 cells/mm3. Exclusion criteria included patients with known rifampicin-resistant tuberculosis and those unable to provide informed consent. First episodes of tuberculosis were treated as per national policy with standard fixed dose combination tablets composed of rifampicin (R), isoniazid (H), pyrazinamide (Z), and ethambutol (E) for the 2-month intensive phase followed by RH for the 4month continuation phase. For retreatment tuberculosis, RHZE was given for 3 months with 40-doses of streptomycin followed by RHE for 5 months. Prior to 1st April 2010, first-line ART comprised stavudine (d4T), lamivudine (3TC) and efavirenz as the preferred non-nucleoside reverse transcriptase inhibitor (NNRTI) in patients on concurrent TB therapy. In April 2010 new national guidelines were introduced with tenofovir (TdF) replacing d4T. Unless contraindicated, all patients received cotrimoxazole 960 mg daily as prophylaxis, and pyridoxine 25?0 mg daily during tuberculosis treatment as well as subcutaneous unfractionated heparin (5000 IU subcutaneously 12 hrly) for deep vein thrombosis prophylaxis if bedbound.EthicsThe study was approved by the University of Cape Town’s Faculty of Health Sciences Research Ethics Committee (HREC No: 049/2009) and the Provincial Research Committee of the Department of Health, Western Cape. All participants signed written informed consent.Statistical AnalysisData were analysed using Stata version 12.0 (Stata Corporation, USA). Measures were described 23977191 with medians and interquartile ranges (IQR) or proportions. We used chi-square tests (replaced by exact tests for sparse data) to compare proportions, rank-sum tests to compare medians, and t-tests to compare mean values between groups. Kaplan-Meier methods were used to describe the survival of patients over time.Results Patient CharacteristicsA total of 130 participants were screened for enrollment (figure 1), 112 of whom met inclusion criteria and started ART in hospital. Baseline characteristics are shown in table 1. The cohort was characterised by advanced immunosuppression with WHO stage 4 disease in the majority, very low median CD4 cell count, high baseline HIV viral load and 81 were bed-bound. Approximately two thirds had disseminated.
