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| |  Nevirapine-Based Antiretroviral Therapy Is an Effective Long-Term Treatment for Patients Co-infected With HIV and Tuberculosis: Presented at AIDS 2010 By Jenny Powers VIENNA -- July 26, 2010 -- Patients co-infected with HIV and tuberculosis (TB) experienced low rates of TB recurrence, maintained CD4 cell counts, and demonstrated reduced viral load at 4 years with nevirapine-based antiretroviral treatment (ART) plus rifampicin, according to study results presented here at the 18th International AIDS Conference. For the past 5 years, efavirenz has been used in combination as first-line treatment in preference to protease inhibitors. For patients coinfected with HIV and TB who cannot tolerate efavirenz, or who are living in resource-poor countries, a nevirapine-based ART and rifampicin-containing antituberculous regimen has been demonstrated to be effective over 3 years of treatment. Weerawat Manosuthi, MD, Bamrasnaradura Infectious Diseases Institute, Ministry of Public Health in Nonthaburi, Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand, reported these results on July 20. This study included 70 patients with HIV who were already receiving rifampicin for active TB and 70 patients with HIV who did not have TB (controls). Both groups received treatment with stavudine, lamivudine, and nevirapine (400 mg/day). All patients were monitored throughout 192 weeks of ART; plasma HIV-1 RNA and CD4 cell counts were recorded every 12 weeks until 96 weeks and every 24 weeks thereafter. In the TB group, the median (interquartile range [IQR]) duration of nevirapine plus rifampicin was 5.4 (4.6-6.1) months. At 4 years, the median (IQR) CD4 cell count was 352 (271-580) cells/mm3 in the TB group and 425 (308-615) cells/mm3 in the controls (P = .238). The proportion of patients to achieve HIV-1 RNA levels <50 copies at the 4-year time point was 62.9% and 60.0% in the TB and control groups, respectively (P = .862) by modified intent-to-treat analysis. The cumulative proportion of ART discontinuation due to any reason at weeks 48, 96, 144, and 192 were 20%, 33%, 36%, and 43%, respectively. The most common reasons for change or discontinuation of ART were lipodystrophy, loss to follow-up, virological rebound, and death in both groups. Within the TB group, 54 (77%), 7 (10%), 6 (9%), 2 (3%), and 1 (1%) patients were cured/completed treatment, defaulted, died, transferred out, or experienced recurrence, respectively. One TB-related death was recorded. [Presentation title: Treatment Outcomes of Patients Co-infected With HIV and Tuberculosis Who Received Nevirapine-Based Antiretroviral Regimen: A 4-Year Prospective Study. Abstract TUPDB305]
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