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Free Content Outcomes and safety of concomitant nevirapine and rifampicin treatment under programme conditions in Malawi

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SETTING: Thyolo District Hospital, rural Malawi.

OBJECTIVES: To report on 1) clinical, immunological and virological outcomes and 2) safety among human immunodeficiency virus (HIV) infected patients with tuberculosis (TB) who received concurrent nevirapine (NVP) and rifampicin (RMP) based treatment.

DESIGN: Retrospective cohort study.

METHODS: Analysis of programme data, June–December 2007.

RESULTS: Of a total of 156 HIV-infected TB patients who started NVP-based antiretroviral treatment, 136 (87%) completed TB treatment successfully, 16 (10%) died and 5 (4%) were transferred out. Mean body weight and CD4 gain (adults) were respectively 4.4 kg (95%CI 3.3–5.4) and 140 cells/mm3 (95%CI 117–162). Seventy-four per cent of patients who completed TB treatment and had a viral load performed (n = 74) had undetectable levels (<50 copies/ml), while 17 (22%) had a viral load of 50–1000 copies/ml. Hepatotoxicity was present in 2 (1.3%) patients at baseline. Two patients developed Grade 2 and one developed Grade 3 alanine transaminase enzyme elevations during TB treatment (incidence rate per 10 years of follow-up 4.2, 95%CI 1.4–13.1). There were no reported deaths linked to hepatotoxicity.

CONCLUSIONS: In a rural district in Malawi, concomitant NVP and RMP treatment is associated with good TB treatment outcomes and appears safe. Further follow-up of patients would be useful to ascertain the longer-term effects of this concurrent treatment.
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Keywords: HIV; Malawi; alanine transferase; nevirapine; rifampicin; tuberculosis

Document Type: Regular Paper

Affiliations: 1: Médecins sans Frontières, Thyolo District, Thyolo, Malawi 2: Medical Department (Operational Research), Brussels Operational Centre, Médecins sans Frontières, Brussels, Belgium 3: Operations Department, Brussels Operational Centre, Médecins sans Frontières, Brussels, Belgium 4: Ministry of Health and Population, Thyolo, Malawi 5: National TB Control Programme, Ministry of Health, Lilongwe, Malawi 6: International Union Against Tuberculosis and Lung Disease, Paris, France; and London School of Hygiene & Tropical Medicine, London, UK

Publication date: February 1, 2010

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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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