TB e HIV nelle coorti

Transcription

1 TB e HIV nelle coorti Antonella d Arminio Monforte Clinica di Malattie Infettive Dipartimento di Scienze della Salute Università degli Studi di Milano Presidio Ospedalero San Paolo, ASST Santi Paolo e Carlo Milano

2 Outline Tubercolosi in Europa Tb e HIV MDR e Eastern Europe Mortalità per Tb Dati Icona Recupero viro-immunologico in corso di ART

3 TB notifications by country In 2013, TB cases were reported in the EU/EEA. The notification rate was 12.7 per population (range ). Figure 1: TB notification rate per population by country, EU/EEA, 2013 < 5 per to 9 per to 19 per to 49 per per Not included or not reporting

4 TB cases of foreign origin In 2013, the proportion of TB cases of foreign origin in the EU/EEA was 28.0% (range %). Figure 6: Percentage of TB cases of foreign origin by country, EU/EEA, 2013 < 1% 1 to 24.9% 25 to 49.9% 50 to 74.9% 75% Not included or not reporting 4

5 Multidrug-resistant TB among all TB cases In 2013, the proportion of TB cases with multidrugresistance in the EU/EEA was 4.1% (range %). Figure 9: Percentage of MDR TB among all confirmed TB cases by country, EU/EEA, 2013 < 1% 1 to 1.9% 2 to 4.9% 5 to 9.9% 10% Not included or not reporting 5

6 TB/HIV co-infection In 2013, the proportion HIV positive among TB cases with known HIV status in EU/EEA was 4.9% (range %). Figure 14: Percentage of HIV-positive cases among TB cases with known HIV status, by country, EU/EEA, 2013 < 1% 1 to 4.9% 5 to 9.9% 10% Not reporting 6

7 PLOS ONE DOI: /journal.pone December 30, / 17 Objectives Rates of TB/HIV coinfection and multi-drug resistant (MDR)-TB are increasing in Eastern Europe (EE). We aimed to study clinical characteristics, factors associated with MDR-TB and predicted activity of empiric anti-tb treatment at time of TB diagnosis among TB/HIV coinfected patients in EE, Western Europe (WE) and Latin America (LA).

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23 In conclusion, our analysis showed that HIV-infected patients starting cart when ART naive and with a tuberculosis diagnosis have an impaired immune recovery with cart,mainly because of differences in level of viral suppression between them and both patients with nontuberculosis AIDS and those without AIDS. Further studies need to be performed to determine whether our findings may be explained by pharmacokinetic interactions between the 2 treatments or to specific interactions between M. tuberculosis and HIV or both. Nevertheless, our results suggest that strategies aimed at preventing tuberculosis cases may increase the chances of virological and immunological response to cart

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25 Introduction CROI 2016 Poster 751 Tuberculosis (TB) may play an important role in immune recovery and HIV replication after ART initiation among HIV-infected individuals. We examined the CD4 cell and HIV-RNA viral load changes on ART in patients without, with prevalent or a history of TB.

26 Baseline Characteristics- Cohere CROI 2016; Boston February Poster 751

27 Results CD4 cell increases were lower in patients with prevalent and recent TB compared to patients without a TB history. This effect was more pronounced in the first months of ART and in patients with higher baseline CD4 count. Patients with prevalent TB had slower overall viral load decline especially during the first months of ART. Patients with recent TB showed a slower viral load decline only during the first 6 months of ART. Non-European, especially Sub-Saharan Africa origin, was associated with lower CD4 increases and slower HIV-RNA declines, as was female sex. Older age was associated with lower CD4 increases but faster viral load declines. CROI 2016; Boston February Poster 751

28 Modelled CD4 cell trajectories (A), and HIV RNA viral load trajectories (adjusted) (B) in HIV-positive patients presenting with tuberculosis (TB) at ART start without a history of TB Fitted change for a male reference patient, 38 years, European, heterosexual, on cart at baseline A B CROI 2016; Boston February Poster 751

29 Associations of CD4 cell count and HIV-RNA viral load changes after starting ART in HIV-positive patients with prevalent TB at ART start and a recent history of TB compared to patients without a history of TB

30 Conclusions TB had a significant effect on virological and immunological response to ART which was most pronounced during the first year of ART. CD4 cell recovery after ART start was worse in patients presenting with prevalent or recent TB. Viral load decline tended to be slower only in patients with prevalent TB. These effects were more pronounced in patients from high-tb incidence countries who may require attention in clinical management. CROI 2016; Boston February Poster 751

31 TB and HIV in the cohorts: conclusions Also from data of the cohorts of HIV patients it is evident that epidemics in Eastern Europe is more dramatic, more severe and more often sustained by MDR Tb as compared to epidemics in Western Europe. In Italy, most cases of HIV-Tb occur in non Italian people, and in severely immunodepressed patients Patients with HIV-Tb have a less pronuonced immune reconsititution in the first year of ART Special attention may be required in recent TB cases starting ART