Antiretroviral therapy initiation during tuberculosis treatment and HIV-RNA and CD4 T-lymphocyte responses
Abstract:SETTING: A large human immunodeficiency virus (HIV) clinic in South Africa.
OBJECTIVE: To examine the effect of initiating antiretroviral therapy (ART) on CD4 and viral response at different time periods during anti-tuberculosis treatment (<14 days, 15–60 days, or ≥60 days) using prospectively collected clinical data.
METHODS: Cohort data analysis for 1499 patients with tuberculosis (TB) and HIV co-infection classified according to timing of ART after the initiation of anti-tuberculosis treatment.
RESULTS: In adjusted modified Poisson regression models, CD4 and viral responses showed no significant differences according to timing of ART initiation (failure to increase CD4 by 6 months, <14 days vs. >60 days: RR 1.02, 95%CI 0.85–1.22; 15–60 days vs. >60 days: RR 1.00, 95%CI 0.86–1.15; failure to suppress virus by 6 months, <14 days vs. >60 days: RR 0.98, 95%CI 0.59–1.63; 15–60 days vs. >60 days: RR 0.96, 95%CI 0.66–1.41 and viral rebound at 12 months, 14 days vs. >60 days: RR 1.43, 95%CI 0.50–4.12; 15–60 days vs. >60 days: RR 1.14, 95%CI 0.39–3.34). Similar estimates were found in analysis restricted to patients with severe immunosuppression.
CONCLUSION: Concerns over the overlapping impact of anti-tuberculosis treatment with ART on ART response should not be a reason for delaying ART in patients with HIV-associated TB.
Document Type: Research Article
Affiliations: 1: Clinical HIV Research Unit, Department of Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Right to Care, Johannesburg, South Africa 2: Department of Obstetrics & Gynecology, Duke Global Health Institute, Duke University, Durham, North Carolina, USA 3: Infectious Diseases Unit, Department of Medicine, Helen Joseph Hospital, University of the Witwatersrand, Johannesburg, South Africa 4: Clinical HIV Research Unit, Department of Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa 5: Right to Care, Johannesburg, South Africa
Publication date: October 1, 2012
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