Abstract
BackgroundFor antiretroviral therapy (ART) naive human immunodeficiency virus (HIV) infected adults suffering from tuberculosis (TB), there is uncertainty about the optimal time to initiate highly active antiretroviral therapy (HAART) after starting antituberculosis treatment (ATT), in order to minimize mortality, HIV disease progression, and adverse events.MethodsIn a randomized, open label trial at All India Institute of Medical Sciences, New Delhi, India, eligible HIV positive individuals with a diagnosis of TB were randomly assigned to receive HAART after 2-4 or 8-12 weeks of starting ATT, and were followed for 12 months after HAART initiation. Participants received directly observed therapy short course (DOTS) for TB, and an antiretroviral regimen comprising stavudine or zidovudine, lamivudine, and efavirenz. Primary end points were death from any cause, and progression of HIV disease marked by failure of ART.FindingsA total of 150 patients with HIV and TB were initiated on HAART: 88 received it after 2-4 weeks (early ART) and 62 after 8-12 weeks (delayed ART) of starting ATT. There was no significant difference in mortality between the groups after the introduction of HAART. However, incidence of ART failure was 31% in delayed versus 16% in early ART arm (p = 0.045). Kaplan Meier disease progression free survival at 12 months was 79% for early versus 64% for the delayed ART arm (p = 0.05). Rates of adverse events were similar.InterpretationEarly initiation of HAART for patients with HIV and TB significantly decreases incidence of HIV disease progression and has good tolerability.Trial registrationCTRI/2011/12/002260
Highlights
For antiretroviral therapy (ART) naive human immunodeficiency virus (HIV) infected adults suffering from tuberculosis (TB), there is uncertainty about the optimal time to initiate highly active antiretroviral therapy (HAART) after starting antituberculosis treatment (ATT), in order to minimize mortality, HIV disease progression, and adverse events
The results of this study show that once highly active antiretroviral therapy (HAART) is started, there is no significant difference in mortality between HIV and TB (HIV-TB) patients who were started on HAART 2-4 weeks after initiation of antituberculosis treatment, and those who received it 8-12 weeks after starting ATT
The risk for progression of HIV disease, as estimated by onset of failure of ARV therapy, increases significantly if initiation of HAART is deferred from 2-4 weeks to 8-12 weeks (16% vs. 31% risk, p = 0.045)
Summary
For antiretroviral therapy (ART) naive human immunodeficiency virus (HIV) infected adults suffering from tuberculosis (TB), there is uncertainty about the optimal time to initiate highly active antiretroviral therapy (HAART) after starting antituberculosis treatment (ATT), in order to minimize mortality, HIV disease progression, and adverse events. According to 2010 report of Joint United Nations Programme on HIV and AIDS (UNAIDS), the global burden of human immunodeficiency virus (HIV) infection was 33.3 million in 2009, with 2.6 million incident cases and 1.8 million acquired immune deficiency syndrome (AIDS) related deaths [1]. Even though the endemic is maintained predominantly by non HIV TB cases, the situation gets complicated by India being the third highest HIV burdened country. As per 2009-2010 report from National AIDS Control Organization (NACO), the prevalence of HIV infection by the end of 2008 was 0.29% in Indian adults [6]. Among TB patients in the country, HIV prevalence was as high as 6.7% in the same year according to WHO estimates. About 4.85% of incident TB cases in India were HIV positive in 2007 [5]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
