Antiretroviral therapy in HIV‐infected patients with tuberculosis and chronic viral hepatitis

Abstract

BackgroundThe purpose of the study was to determine the influence of an HIV infection with tuberculosis or chronic viral hepatitis on efficiency and safety during 48 weeks of HAART.MethodsHAART was received by 327 naïve HIV patients (pts). Clinical symptoms of an HIV infection had 273 pts (83.5%). The 1st group ‐ 59 HIV pts with tuberculosis, the 2nd group ‐ 217 HIV pts with chronic viral hepatitis, the 3rd group ‐ 51 HIV‐monoinfected pts. All pts were treated with 2 NRTI + EFV/PI. Evaluation of HAART efficacy based on the change of amount CD4 cells and RNA HIV level after 24 and 48 weeks therapy. Safety of HAART was evaluated on the frequency of adverse events and the change of laboratory abnormalities.ResultsAfter 24 weeks 61–72% of patients had undetectable RNA HIV level. CD4 cells increased in all groups. The percentage of pts with low CD4 cells (<200 cells/mm3) decreased from 40–55% to 26–30%. After 48 weeks HAART CD4 cells increased by 90–127 cells/mm3 (vs baseline) in all pts, however 17.4–26.7% pts saved low CD4 cells. Undetectable RNA HIV level registered in 75.6% pts with tuberculosis and 87.5–88.8% other pts. The proportion of pts who had adverse events was more among 1st and 2nd groups as compared as HIV‐monoinfected pts (33–35% and 19%, p < 0.05) after 24 weeks of therapy. After 48 weeks HAART the frequency of adverse events and laboratory abnormalities decreased to 20–28% in 1st and 2nd groups and to 2% in 3rd group. The most frequent we observed CNS disorders (grade 1) due to EFV and gastrointestinal symptoms due to PI or Combivir (CBV). In pts with accompanying diseases the frequent increase of ALT level was observed in 30–40%, in HIV‐monoinfected pts ‐ 4–10%. The frequency of interruption HAART was greatest among patients with tuberculosis ‐ 14.3% (vs 5% and 5.8% in patients with hepatitis and monoinfected patients). In general, the interrupt has been associated with the combination of side effects of antiretroviral and antituberculosis drugs.ConclusionsAvailability of chronic liver disease or tuberculosis almost have no influence on the HAART efficacy. However, essential increase the frequency of adverse events HAART that leads to change HAART regimen or interruption it.