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Safety and effectiveness of HAART in tuberculosis-HIV co-infected patients in Brazil

Authors: dos Santos, A. P. G.1; Pacheco, A. G.2; Staviack, A.1; Golub, J. E.3; Chaisson, R. E.3; Rolla, V. C.2; Kritski, A. L.1; Passos, S. R. L.2; de Queiroz Mello, F. C.1

Source: The International Journal of Tuberculosis and Lung Disease, Volume 17, Number 2, 1 February 2013 , pp. 192-197(6)

Publisher: International Union Against Tuberculosis and Lung Disease

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Abstract:

BACKGROUND: Antiretroviral therapy (ART) significantly reduces tuberculosis (TB) incidence among persons with human immunodeficiency virus (HIV), but the safety and effectiveness of concomitant treatment for both diseases remain unclear.

OBJECTIVE: To evaluate the impact of ART and anti-tuberculosis treatment on survival and risk of adverse events (AE) among co-infected individuals.

METHODS: In a retrospective cohort study, clinical data were collected from 618 TB-HIV patients treated with rifampin, isoniazid and pyrazinamide ± ethambutol between 1 January 1995 and 31 December 2003. Patients were categorized into two groups: highly active ART (HAART) or no ART. Different HAART regimens were evaluated. Bivariate analysis, multivariate logistic regression and survival analysis using Cox proportional hazards regression were used.

RESULTS: One-year mortality was lower for patients receiving HAART (adjusted hazard ratio [aHR] 0.17, 95%CI 0.09–0.31) compared to no ART. HAART increased the risk of AE (aHR 2.08, 95%CI 1.29–3.36). The odds of AE when receiving a ritonavir + saquinavir HAART regimen was eight-fold higher compared to no ART (OR 8.31, 95%CI 3.04–22.69), while efavirenz-based HAART was not associated with a significantly increased risk of AE (OR 1.42, 95%CI 0.76–2.65).

CONCLUSION: HIV patients with TB have significantly better survival if they receive HAART during anti-tuberculosis treatment. Efavirenz-based HAART is associated with fewer AEs than protease inhibitor-based HAART.

Keywords: AIDS; HAART; adverse events; survival; tuberculosis

Document Type: Research Article

DOI: http://dx.doi.org/10.5588/ijtld.11.0831

Affiliations: 1: Institute of Thoracic Diseases, Clementino Fraga Filho University Hospital, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil 2: Evandro Chagas Clinical Research Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Rio de Janeiro, Brazil 3: Johns Hopkins University, Baltimore, Maryland, USA

Publication date: February 1, 2013

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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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