Operationalizing early antiretroviral therapy in HIV-infected in-patients with opportunistic infections including tuberculosis
METHODS: Patients admitted with HIV and concurrent TB or other OI were initiated on early in-patient ART. The primary and secondary endpoints were respectively 24-week mortality and 24-week virologic suppression. Multivariable logistic regression modeling explored the associations between baseline (i.e., pre-hospital discharge) characteristics and mortality at 24 weeks.
RESULTS: A total of 382 patients were prospectively enrolled (48% women, median age 37 years, median CD4 count 33 cells/mm3). Acute OIs were pulmonary TB, 39%; extra-pulmonary TB, 25%; cryptococcal meningitis (CM), 10%; and chronic diarrhea, 9%. The median time from admission to ART initiation was 14 days (range 4–32, IQR 11–18). At 24 weeks of follow-up, as-treated and intention-to-treat virologic suppression were respectively 57% and 93%. Median change in CD4 cell count was +100 cells/mm3, overall 24-week mortality was 25% and loss to follow-up, 5%. Excess mortality was not observed among patients with CM who initiated early ART. A longer interval between admission and ART was associated with mortality (>21 days vs. <21 days after admission OR 2.1, 95%CI 1.2–4.0, P = 0.016).
CONCLUSIONS: For HIV-infected in-patients with TB or an acquired immune-deficiency syndrome defining OI, we demonstrate the operational feasibility of early ART initiation in in-patients.
Document Type: Research Article
Affiliations: 1: McCord Hospital, Durban, South Africa; Infectious Diseases Unit, Nelson Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa 2: McCord Hospital, Durban, South Africa 3: Infectious Diseases Unit, Nelson Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa 4: Centre for Biostatistics in AIDS Research, Harvard School of Public Health, Boston, Massachusetts, USA 5: University of Cape Town School of Medicine, Cape Town, South Africa 6: University of KwaZulu-Natal, Durban, South Africa 7: University of Cape Town, Cape Town, South Africa 8: University of Southern California School of Medicine, Los Angeles, California, USA
Publication date: 2012-07-01
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