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Free Content Antiretroviral therapy initiation during tuberculosis treatment and HIV-RNA and CD4 T-lymphocyte responses

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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.
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Keywords: CD4 response; HIV-TB co-infection; sub-Saharan Africa; timing of HAART; viral response

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: 2012-10-01

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  • The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on tuberculosis and lung health world-wide.

    Certain IJTLD articles are selected for translation into French, Spanish, Chinese or Russian. They are available on the Union website

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