Predictors of Clinical Outcomes Among People With Human Immunodeficiency Virus and Tuberculosis Symptoms After Rapid Treatment Initiation in Haiti.

BACKGROUND

Few studies have evaluated baseline predictors of clinical outcomes among people with human immunodeficiency virus (HIV) starting antiretroviral therapy (ART) in the modern era of rapid ART initiation.

METHODS

We conducted a secondary analysis of a previously reported open-label randomized controlled trial of 2 rapid treatment initiation strategies for people with treatment-naive HIV and tuberculosis symptoms at a large urban clinic in Haiti. We used logistic regression models to assess associations between baseline characteristics and (1) retention in care at 48 weeks, (2) HIV viral load suppression at 48 weeks (among participants who underwent viral load testing), and (3) all-cause mortality. For the viral load suppression outcome, we used inverse probability weighting to account for potential selection bias resulting from exclusion of participants who did not undergo viral load testing.

RESULTS

A total of 500 participants were enrolled in the study from November 2017 to January 2020. Tuberculosis was diagnosed in 88 participants (18%), and ART was started in 494 (99%). After multivariable adjustment, less than secondary school education (adjusted odds ratio [AOR] 0.21 [95% confidence interval (CI), .10-.46]) was significantly associated with a reduced odds of retention in care. Dolutegravir initiation (AOR, 2.57 [95% CI, 1.22-5.43]), age (1.42 per 10-year increase [1.01-1.99]), and tuberculosis diagnosis (3.92 [1.36-11.28]) were significantly associated with increased odds of retention. Age (AOR, 1.36 [95% CI, 1.05-1.75]) and dolutegravir initiation (1.75 [1.07-2.85]) were positively associated with viral suppression, and tuberculosis diagnosis (0.50 [.28-.89) was negatively associated with viral suppression, with similar findings after incorporation of inverse probability weights. Higher CD4 cell count at enrollment was significantly associated with a lower odds of mortality (unadjusted odds ratio, 0.69 [95% CI, .55-.87]), and anemia was associated with a significantly greater odds of mortality (4.86 [1.71-13.81]).

CONCLUSIONS

We identified sociodemographic, treatment-related, clinical, and laboratory-based predictors of clinical outcomes. These characteristics may serve as markers of subpopulations that could benefit from additional interventions to support treatment success after rapid treatment initiation.