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Clin Infect Dis. 2018 Aug 20. doi: 10.1093/cid/ciy718. [Epub ahead of print]

HIV-1 and TB Co-infection in Multinational Resource Limited Settings: Increased neurological dysfunction.

Author information

1
AIDS Neurological Center, Neurology, UNC, Chapel Hill, NC, US.
2
University of Ibadan, Nigeria.
3
Harvard T.H. Chan School of Public Health, Boston, MA, US.
4
Queen Elizabeth, Blantyre, Malawi.
5
Chiang Mai University, Chiang Mai, Thailand.
6
University of Colorado Health Sciences Center, Denver, CO, US.
7
Harare, Zimbabwe.
8
Pune, India.
9
Lilongwe, Malawi.
10
University of Washington, Seattle, WA.
11
Chennai, India.
12
Vita-Salute San Raffaele University, Milan, Italy.
13
Lima, Peru.
14
Porto Alegre, Brazil.
15
Fiocruz, Rio De Janeiro, Brazil.
16
Johannesburg, South Africa.
17
University of California San Francisco.
18
Northwestern University, Chicago, IL.
19
Social Scientific Systems, South Africa.
20
Durban, South Africa.
21
Frontier Science & Technology Research Foundation, Baltimore, MD.
22
Johns Hopkins University, Baltimore, MD.

Abstract

Background:

AIDS Clinical Trial Group (ACTG) 5199 compared neurological and neuropsychological (NP) test performance of HIV-1+ participants in resource-limited settings (RLS) treated with three WHO recommended antiretroviral (ART) regimens. We investigated the impact of tuberculosis (TB) on neurological and neuropsychological outcomes.

Methods:

Standardized neurological and brief NP examinations were administered to participants every 24 weeks. Generalized estimating equation (GEE) models assessed the association between TB with neurological and NP performance.

Results:

Characteristics of the 860 participants at baseline were: 53% female, 49% African; median age 34 years; CD4 of 173 cells/mm 3; and plasma HIV-1 RNA of 5.0 log c/mL. At baseline, there were 36 cases of pulmonary, 9 cases of extrapulmonary (1 with both), and one case of CNS TB. Over the 192 weeks of follow-up after baseline there were 55 observations of pulmonary TB in 52 persons, 26 observations of extrapulmonary TB in 25 persons, and 3 observations of CNS TB in 2 persons. Prevalence of TB decreased with ART initiation and follow-up. Those with TB co-infection had significantly poorer performance on Grooved Pegboard (p< 0.001) and Fingertapping Non-Dominant hand (p<0.01). TB was associated with diffuse CNS disease (p<0.05). Furthermore, those with TB had 9.27 times (p< 0.001) higher odds of reporting decreased quality of life, and had 8.02 times (p= 0.0005) higher odds of loss of productivity.

Conclusions:

TB co-infection was associated with poorer neuropsychological functioning, particularly the fine motor skils, and had a substantial impact on functional ability and quality of life.

Clinical Trials Identifier:

NCT00096824 http://clinicaltrials.gov/ct2/show/NCT00096824?term=international+neurological&recr=Closed&type=Obsr&rank=1.

PMID:
30137250
PMCID:
PMC6495021
[Available on 2019-08-20]
DOI:
10.1093/cid/ciy718

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