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Early initiation of antiretroviral therapy results in decreased morbidity and mortality among patients with TB and HIV.

Tabarsi P, Saber-Tehrani AS, Baghaei P, Padyab M, Mansouri D, Amiri M, Masjedi MR, Altice FL - J Int AIDS Soc (2009)

Bottom Line: There were no differences between Groups I and II with regard to: adverse drug reactions [four (8.5%) versus two (9%), p = ns]; IRIS [six (12.7%) versus three (10.7%), p = ns]; and new opportunistic infections [eight (17.0%) versus two (9.1%), p = ns].Injection of drugs was the most common route of HIV transmission in both groups (72.3% in Group I and 77.3% in Group II).This manuscript shows that in a retrospective review of HIV/TB patients hospitalized in Tehran, improved survival was associated with earlier initiation of antiretroviral therapy in HIV/TB patients with CD4 counts of below 100 cells/mm3.

View Article: PubMed Central - HTML - PubMed

Affiliation: Mycobacteriology Research Center, National Research Institute of Tuberculosis and Lung Disease, Shahid Beheshti University of Medical Science, Tehran, Iran. tabarsi@nritld.ac.ir.

ABSTRACT

Introduction: The overlapping drug toxicity profiles, drug-drug interactions and complications of management of both HIV and tuberculosis (TB) in patients with advanced HIV have not been fully delineated.

Methods: We conducted a retrospective chart review of the outcomes of tuberculosis treatment among 69 HIV-infected patients with TB, who were hospitalized in Masih Daneshvari Hospital in Tehran, Iran between 2002 and 2006, and who received standard category 1 (CAT-1) regimens. Group I (N = 47) included those treated from 2002 to 2005 with highly active antiretroviral therapy (HAART) initiated after eight weeks of TB treatment for those whose CD4 count was <200 cells/mm3. Group II (N = 22) included TB patients treated from 2005 to 2006, with HAART initiated after two weeks of TB treatment if their CD4 count was <100 cells/mm3 and eight weeks after initiation of TB treatment for those whose CD4 count was between 101 and 200 cells/mm3.

Results: There were no differences between Groups I and II with regard to: adverse drug reactions [four (8.5%) versus two (9%), p = ns]; IRIS [six (12.7%) versus three (10.7%), p = ns]; and new opportunistic infections [eight (17.0%) versus two (9.1%), p = ns]. Death, however, occurred more frequently in Group I than in Group II [13 (27.7%) versus (4.5%), p = 0.03], where HAART was initiated earlier. Injection of drugs was the most common route of HIV transmission in both groups (72.3% in Group I and 77.3% in Group II).

Conclusion: This manuscript shows that in a retrospective review of HIV/TB patients hospitalized in Tehran, improved survival was associated with earlier initiation of antiretroviral therapy in HIV/TB patients with CD4 counts of below 100 cells/mm3.

No MeSH data available.


Related in: MedlinePlus

Kaplan-Meier curve of HIV/TB co-infected patients and time to death.
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Figure 1: Kaplan-Meier curve of HIV/TB co-infected patients and time to death.

Mentions: Table 2 provides the treatment outcomes of the two groups. The most common adverse reaction was drug-induced hepatitis, which occurred in 14.5% of the patients. The proportion of subjects with IRS was 13%, and adverse cutaneous reactions occurred in 7.7% of subjects. No difference was observed between the two groups for any of these complications of therapy. The Kaplan-Meier curve for HIV and TB co-infected patients is shown in Figures 1 and 2. Death, within 12 months after diagnosis, was 7.2 times more likely in Group I than in Group II (95% confidence interval 1.87–27.64, p value = 0.03).


Early initiation of antiretroviral therapy results in decreased morbidity and mortality among patients with TB and HIV.

Tabarsi P, Saber-Tehrani AS, Baghaei P, Padyab M, Mansouri D, Amiri M, Masjedi MR, Altice FL - J Int AIDS Soc (2009)

Kaplan-Meier curve of HIV/TB co-infected patients and time to death.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2734561&req=5

Figure 1: Kaplan-Meier curve of HIV/TB co-infected patients and time to death.
Mentions: Table 2 provides the treatment outcomes of the two groups. The most common adverse reaction was drug-induced hepatitis, which occurred in 14.5% of the patients. The proportion of subjects with IRS was 13%, and adverse cutaneous reactions occurred in 7.7% of subjects. No difference was observed between the two groups for any of these complications of therapy. The Kaplan-Meier curve for HIV and TB co-infected patients is shown in Figures 1 and 2. Death, within 12 months after diagnosis, was 7.2 times more likely in Group I than in Group II (95% confidence interval 1.87–27.64, p value = 0.03).

Bottom Line: There were no differences between Groups I and II with regard to: adverse drug reactions [four (8.5%) versus two (9%), p = ns]; IRIS [six (12.7%) versus three (10.7%), p = ns]; and new opportunistic infections [eight (17.0%) versus two (9.1%), p = ns].Injection of drugs was the most common route of HIV transmission in both groups (72.3% in Group I and 77.3% in Group II).This manuscript shows that in a retrospective review of HIV/TB patients hospitalized in Tehran, improved survival was associated with earlier initiation of antiretroviral therapy in HIV/TB patients with CD4 counts of below 100 cells/mm3.

View Article: PubMed Central - HTML - PubMed

Affiliation: Mycobacteriology Research Center, National Research Institute of Tuberculosis and Lung Disease, Shahid Beheshti University of Medical Science, Tehran, Iran. tabarsi@nritld.ac.ir.

ABSTRACT

Introduction: The overlapping drug toxicity profiles, drug-drug interactions and complications of management of both HIV and tuberculosis (TB) in patients with advanced HIV have not been fully delineated.

Methods: We conducted a retrospective chart review of the outcomes of tuberculosis treatment among 69 HIV-infected patients with TB, who were hospitalized in Masih Daneshvari Hospital in Tehran, Iran between 2002 and 2006, and who received standard category 1 (CAT-1) regimens. Group I (N = 47) included those treated from 2002 to 2005 with highly active antiretroviral therapy (HAART) initiated after eight weeks of TB treatment for those whose CD4 count was <200 cells/mm3. Group II (N = 22) included TB patients treated from 2005 to 2006, with HAART initiated after two weeks of TB treatment if their CD4 count was <100 cells/mm3 and eight weeks after initiation of TB treatment for those whose CD4 count was between 101 and 200 cells/mm3.

Results: There were no differences between Groups I and II with regard to: adverse drug reactions [four (8.5%) versus two (9%), p = ns]; IRIS [six (12.7%) versus three (10.7%), p = ns]; and new opportunistic infections [eight (17.0%) versus two (9.1%), p = ns]. Death, however, occurred more frequently in Group I than in Group II [13 (27.7%) versus (4.5%), p = 0.03], where HAART was initiated earlier. Injection of drugs was the most common route of HIV transmission in both groups (72.3% in Group I and 77.3% in Group II).

Conclusion: This manuscript shows that in a retrospective review of HIV/TB patients hospitalized in Tehran, improved survival was associated with earlier initiation of antiretroviral therapy in HIV/TB patients with CD4 counts of below 100 cells/mm3.

No MeSH data available.


Related in: MedlinePlus