Initiation of antiretroviral therapy in HIV‐infected tuberculosis patients in rural Kenya: an observational study

Abstract

To provide information on the effect of timing of antiretroviral therapy (ART) initiation on outcomes of TB infection in real-life, non-clinical trial, rural settings in sub-Saharan Africa. We conducted an observational cohort study of all HIV-infected TB patients presenting to a rural hospital in Kenya between 2005 and 2009. We analysed the association between timing of initiation of ART and mortality, using a Cox regression survival analysis, adjusted for measured confounders. A total of 404 antiretroviral-naïve HIV/TB coinfected patients were included in the study. Initiation of ART during the first 8weeks of TB treatment (early group) was not associated with changes in mortality at 1year compared with initiation of ART after 8weeks (late group) [Hazard Ratio (HR)=0.74 (Confidence Interval (CI), 0.33-1.64, P=0.46]. In patients with baseline CD4 counts ≤50cells/μl, there was a significant reduction in mortality in the early group compared with the late group (HR=0.20; 95% CI, 0.042-0.99; P=0.049). In patients with a CD4 count >50cells/μl, there was no significant difference between early and late groups (HR 1.79; 95% CI, 0.64-5.03; P=0.27). We found that in HIV/TB coinfected patients in rural Kenya, early ART initiation (within 8weeks) was associated with reduced mortality in those with CD4 counts ≤50cells/μl. In patients with CD4 counts >50cells/μl, there was no association seen between timing of ART and mortality.