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Original Article DOI: 10.7241/ourd.20132.34 EFFECT OF ANTIRETROVIRAL THERAPY ON SURVIVAL OF HIV/TB-INFECTED PATIENTS IN UKRAINE Mykhailo Andreychyn 1 , Dmytro Zhyvytsia 2 Source of Support: Nil Competing Interests: None 1 Department Infectious Diseases, Epidemiology and Dermatovenerology of I.YA. Horbachevsky Ternopil State Medical University, Ukraine 2 Department of Infectious Diseases Zaporizhia Medical Academy of Postgraduate Education, Ukraine Corresponding author: Mariia Shkilna, MD, PhD nadiya20743@gmail.com <strong>Our</strong> Dermatol <strong>Online</strong>. 2013; 4(2): 149-152 Date of submission: 19.10.2012 / acceptance: 20.11.2012 Abstract Introduction: There is little information from Ukraine about the effect of highly active antiretroviral therapy (HAART) on survival of HIV/ TB-infected patients. We evaluated the survival and the effect of HAART on mortality on these patients. Methods: Prospective cohort study of HIV patients who developed TB from January 2005 to December 2006 in a Zaporizhzhya AIDS Center, and were tracked for 60 months after start HAART. Survival was determined by Kaplan-Meier method and effect of HAART on survival was evaluated using Cox proportional hazards models. Results: Eighty patients were studied (mean age 34 years, 50% male, median CD4 count 103 cell/μL). In 60 months of HAART 14 patients died. The probability of survival was 82%. In multivariate analysis, patients with a CD4 cell count
Extra-pulmonary TB was considered when there was clinical evidence and positive Ziehl-Nielsen in biopsy from at least one extra-pulmonary location, with or without pulmonary TB. In general anti-TB therapy was standard according to the World Health Organization (WHO). All patients included in the study received antituberculosis medications as directly observed therapy and in accordance with standard Category 1 regimens. Prophylactic regimens against opportunistic infections were provided in accordance with national Ukrainian guidelines during all time of the study. The HAART regimens consisted of three-drug therapy using combinations listed by the WHO as approved first-line regimens. Statistical analysis Median (interquartile range, IQR), and frequencies (%) were used to describe patients’ characteristics in each group. The Kaplan-Meier test was used to estimate the probability of death and the median time to death. To compare survival by baseline immunological status, the Kaplan-Meier analysis was further stratified by baseline CD4 count (200 cells/μL). The hazard ratio (HR) and its 95% confidence interval (CI) derived from univariate and multivariate Cox proportional hazards models. All analyses were performed using STATISTICA 6.0 and SPSS 17.0. A P value less than 0.05 was considered statistically significant. Results A total of 80 patients who met the inclusion criteria were identified. Time of follow-up was 60 months. Mean age at initial presentation was 34 years (range 18-54 years). Forty patients (50%) were female. The median (IQR) CD4 cell count was 103 μL (63-182). Thirty-seven patients (46%) had an initial CD4 cell count 200/ μL (Tabl. I). Injection drug use was the most common route (65%) of HIV transmission. The number of patients co-infected with the hepatitis C virus (HCV) was 57 (71%). Specific HAART regimens included zidovudine-lamivudineefavirenz, administered to 70 (88%) of the patients; stavudine-lamivudine-efavirenz, administered to 10 (12%). The baseline demographic and clinical characteristics are provided in Table I. The probabilities of survival after start HAART estimated by the Kaplan-Meier method is shown in Figure 1. Survival rates at 1, 2, 3, 4 and 5 years were 95%, 92%, 86%, 86%, and 82%. Among 14 patients who died, 12 patients (86%) died during the first 36 months of HAART. Five of the 14 patients who died, had CD4 counts less than 50 cells/μL. The causes of death were TB (12 cases), primary CNS lymphoma and cryptococal meningitis (one case for each). Among the 5 patients with HIV-related deaths that occurred during the first 12 months of HAART, we identified 4 in whom death could be attributed to IRIS (all case of tuberculosis meningitis). Univariate analysis revealed that a baseline CD4 cell count
Page 1 and 2: Volume 4, Number 2, April 2013 ISSN
Page 3: Editorial Board: Abdel-Naser Mohame
Page 6 and 7: CONTENTS E d i t o r i a l O r i g
Page 10 and 11: Figure 1. Survival time of HIV/TB-
Page 12 and 13: Original Article DOI: 10.7241/ourd.
Page 14 and 15: Figure 3. A. melanocytic naevus on
Page 16 and 17: Original Article DOI: 10.7241/ourd.
Page 18 and 19: 82% of the children belonged to the
Page 20 and 21: Comment to the article DOI: 10.7241
Page 22 and 23: The skin around body openings such
Page 24 and 25: Figure 1. Finger nail dystrophy in
Page 28 and 29: Similar type of rash was also prese
Page 30 and 31: 13. Mastaglia FL, Ojeda VJ: Inflamm
Page 32 and 33: Figure 1. Atrophic areas on left up
Page 34 and 35: 5. Brocard A, Quereux G, Moyse D, D
Page 36 and 37: Figure 1. Macroglossia Figure 2. Ma
Page 38 and 39: Case Report DOI: 10.7241/ourd.20132
Page 40 and 41: Figure 4a, b. Skin biopsy shows hyp
Page 46 and 47: Discussion Poikiloderma of Civatte
Page 52 and 53: Case Report A 56 year old Caucasian
Page 54 and 55: Using a battery of neurotoxic agent
Page 56 and 57: Figure 1. Multiple lesions on the u
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Case Report DOI: 10.7241/ourd.20132
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Figure 1. a PAS positive accentuati
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The patient was put on melanocyl 0.
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The type of treatment prescribed by
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On the basis of these clinical find
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Surgery has been reported to be the
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Figure 1. Histological section show
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Discussion The breast location of t
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Figure 2. The epithelial nests show
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Discussion SCACP is one of the cuta
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Figure 1. Tumor of the nasal colume
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Figure 2. Vesicles and crusts aroun
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Outbreaks have occurred recently in
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Clasificación En base al epitelio
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- Microcefalia, hipoplasia mediofac
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Caso Nº 3: · Niña, edad desconoc
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Clinical Images DOI: 10.7241/ourd.2
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Figure 7. Fixed cutaneous sporotric
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Letter to the Editor DOI: 10.7241/o
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Historical Article DOI: 10.7241/our
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Figure 6. Henri Mondor (1885-1962).
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Figure 5. Alfred Guido Miescher (18
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Names of ''Lines'', in dermatology
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Figure 1. Erik Adolf von Willebrand
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THOMAS INMAN English physician, 182
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There are three type of tinea capit
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