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| |  Antiretroviral Therapy Does Not Affect Tuberculosis Treatment in HIV Patients Coinfected With Tuberculosis: Presented at AIDS 2010 By Jenny Powers VIENNA -- July 26, 2010 -- No significant difference was observed in the resolution of tuberculosis (TB) infection in patients with HIV and TB coinfections when some were treated with antiretroviral therapy (ART) and some were not, according to study data reported at the 18th Annual International AIDS Conference. "The hypothesis of our study was whether the induced immune maintenance and recovery in people coinfected with both TB and HIV due to antiretroviral treatment [ART] will have any clinical, radiological, or microbiological responses on TB," explained Gabriel Chamie, MD, University of California, San Francisco, California, speaking here on July 20. This study was based on the current World Health Organization guidelines that recommend the initiation of ART in patients coinfected with HIV and TB, regardless of CD4 cell count, to delay HIV disease progression. The team of investigators from the United States and Uganda examined clinical, radiographic, and microbiologic outcomes (TB smear/culture at 1, 2, and 5 months) for TB in 223 patients infected with HIV (CD4 >350 cells/mcL) who were also diagnosed with pulmonary TB and took part in a randomised trial that compared immediate antiretroviral therapy (ART) and CD4-guided ART initiation in Kampala, Uganda. The intervention arm comprised 109 patients who received 6 months of ART consisting of zidovudine/lamivudine/abacavir (AZT/3TC/ABC) starting at the time of TB treatment. ART was initiated in the 114 patients in the control arm only in cases where CD4 cell counts fell under 250 cells. Patients in the intervention arm had a high suppression of HIV ribonucleic acid (RNA) at 6 months of treatment; 86% of patients achieved a viral load under 400 copies/mL. Regarding TB outcome, however, median time to negative Mycobacterium tuberculosis conversion and to a negative acid-fast bacillus (AFB) smear were not significantly different between the ART treatment group and the control group. Conversion to negative TB culture was a median time of -37 days with ART versus -29 days in the control arm (P = .37). At baseline, 92% of patients had a positive AFB smear, 89% were positive for TB culture, and 61% had cavitary tuberculosis. After 5 months of treatment, a high proportion (18%) of participants had a positive AFB smear and a negative culture, which was associated with cavitation and pleural thickening on baseline x-ray, but not with ART use or TB treatment failure or relapse. TB treatment failure (defined as a positive culture at month 5) was not observed in either arm. There were no significant radiographic or symptomatic differences between the arms at month 12 of treatment. The conclusion was that there was no difference in the outcome of TB therapy outcome when TB-HIV coinfected patients received ART. ART did not accelerate the microbiologic, clinical, or radiographic improvement of TB therapy in HIV/TB coinfected patients with high CD4 counts. Furthermore, the authors noted, using only AFB smear data for the follow up of TB treatment may lead to misclassification of persistently smear-positive patients as treatment failures, despite there being a high likelihood of cure with standard 6-month TB therapy. A high proportion of patients was found to have persistent AFB in their sputum sample late in TB therapy, despite sputum culture conversion, a factor which associates with cavitation and pleural thickening on baseline chest x-ray. [Presentation title: TB Microbiologic and Clinical Outcomes in a Randomized Trial of Immediate vs CD4 Initiated Antiretroviral Therapy (ART) in HIV+ Adults With High CD4 Cell Counts. Abstract TUPDB304]
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