Antiretroviral Therapy and Tuberculosis

Posted by Graham McMahon • October 21st, 2011

When to initiate antiretroviral therapy in patients with newly diagnosed HIV infection and TB has been debated. In a new study from Cambodia, giving antiretrovirals 2 weeks after the start of TB therapy was superior to therapy begun at 8 weeks, with a decrease in mortality.

Tuberculosis is a major cause of death in persons infected with the human immunodeficiency virus (HIV), especially in resource-limited settings.

Clinical Pearls

What is the approximate mortality for patients with tuberculosis?

Mortality among HIV-infected patients has been reported to be approximately 30% within the first 2 months of tuberculosis treatment if antiretroviral therapy (ART) is withheld.

What is the rationale for early initiation of ART?

Arguments that support early initiation of ART include more rapid restoration of the immunocompetence needed to cure the tuberculosis and the enhancement of immune responses to other specific pathogens, thus reducing the risk of opportunistic infections.

Figure 2. Kaplan-Meier Survival Estimates According to Study Group.

Morning Report Questions

Q: As compared to patients who had late initiation of ART, what was the effect of early initiation of ART on survival?

A: Patients in the early-ART group had a significantly higher rate of survival than did those in the late-ART group. In the multivariate analysis, the adjusted hazard ratio for death in the early-ART group, as compared with the late-ART group, was 0.62 (95% CI, 0.44 to 0.86; P=0.006).

Q: What were the most common causes of death among HIV-infected adults with tuberculosis in this study?

A: Drug toxicity was the second most common cause of death, after tuberculosis.

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