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dc.rights.licenseCreative Commons Attribution License
dc.contributor.authorKarat, Aaron S.en
dc.contributor.authorOmar, Tanvieren
dc.contributor.authorvon Gottberg, Anneen
dc.contributor.authorTlali, Mphoen
dc.contributor.authorChihota, Violet N.en
dc.contributor.authorChurchyard, Gavin J.en
dc.contributor.authorFielding, Katherine L.en
dc.contributor.authorJohnson, Suzanneen
dc.contributor.authorMartinson, Neil A.en
dc.contributor.authorMcCarthy, Kerriganen
dc.contributor.authorWolter, Nicoleen
dc.contributor.authorWong, Emily B.en
dc.contributor.authorCharalambous, Salomeen
dc.contributor.authorGrant, Alison D.en
dc.contributor.editorCardona, Pere-Joanen
dc.identifier.citationKarat, A. S., Omar, T., von Gottberg, A., Tlali, M., Chihota, V. N., Churchyard, G. J., Fielding, K. L., Johnson, S., Martinson, N. A., McCarthy, K., Wolter, N., Wong, E. B., Charalambous, S. & Grant, A. D. (2016) Autopsy prevalence of tuberculosis and other potentially treatable infections among adults with advanced HIV enrolled in out-patient care in South Africa. PLOS One, 11(11).en
dc.descriptionAaron S. Karat - ORCID 0000-0001-9643-664X
dc.description.abstractBackground Early mortality among HIV-positive adults starting antiretroviral therapy (ART) remains high in resource-limited settings, with tuberculosis (TB) the leading cause of death. However, current methods to estimate TB-related deaths are inadequate and most autopsy studies do not adequately represent those attending primary health clinics (PHCs). This study aimed to determine the autopsy prevalence of TB and other infections in adults enrolled at South African PHCs in the context of a pragmatic trial of empiric TB treatment (“TB Fast Track”).en
dc.description.abstractMethods and Findings Adults with CD4 150 cells/μL, not on ART or TB treatment, were enrolled to TB Fast Track and followed up for at least six months. Minimally invasive autopsy (MIA) was conducted as soon as possible after death. Lungs, liver, and spleen were biopsied; blood, CSF, and urine aspirated; and bronchoalveolar lavage fluid obtained. Samples underwent mycobacterial, bacterial, and fungal culture; molecular testing (including Xpert® MTB/RIF); and histological examination. 34 MIAs were conducted: 18 (53%) decedents were female; median age was 39 (interquartile range 33–44) years; 25 (74%) deaths occurred in hospitals; median time from death to MIA was five (IQR 3–6) days. 16/34 (47%) had evidence of TB (14/16 [88%] with extrapulmonary disease; 6/16 [38%] not started on treatment antemortem); 23 (68%) had clinically important bacterial infections; four (12%) cryptococcal disease; three (9%) non-tuberculous mycobacterial disease; and two (6%) Pneumocystis pneumonia. Twenty decedents (59%) had evidence of two or more concurrent infections; 9/ 16 (56%) individuals with TB had evidence of bacterial disease and two (13%) cryptococcal disease.
dc.description.abstractConclusions TB, followed by bacterial infections, were the leading findings at autopsy among adults with advanced HIV enrolled from primary care clinics. To reduce mortality, strategies are needed to identify and direct those at highest risk into a structured pathway that includes expedited investigation and/or treatment of TB and other infections.
dc.description.sponsorshipThis study was funded by the Bill and Melinda Gates Foundation (Global Health Grant number OPP1083118; The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.en
dc.relation.ispartofPLOS Oneen
dc.rights© 2016 Karat et al.
dc.titleAutopsy prevalence of tuberculosis and other potentially treatable infections among adults with advanced HIV enrolled in out-patient care in South Africaen
rioxxterms.typeJournal Article/Reviewen
qmu.authorKarat, Aaron S.en
qmu.centreInstitute for Global Health and Developmenten

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