Treatment of tuberculosis in HIV-infected persons in the era of highly active antiretroviral therapy
作者:
Gillian Dean,
Simon Edwards,
Natalie Ives,
Gail Matthews,
Emma Fox,
Lesley Navaratne,
Martin Fisher,
Graham Taylor,
Rob Miller,
Chris Taylor,
Annemiek de Ruiter,
Anton Pozniak,
期刊:
AIDS
(OVID Available online 2002)
卷期:
Volume 16,
issue 1
页码: 75-83
ISSN:0269-9370
年代: 2002
出版商: OVID
关键词: tubercolosis;HIV;adverse events;antiretroviral therapy;CD4;viral load
数据来源: OVID
摘要:
ObjectiveTo assess the risks and benefits of administering highly active antiretroviral therapy (HAART) during the treatment of tuberculosis (TB) in HIV-infected patients.Design and methodsHIV-1 patients presenting to 12 HIV centres in Greater London and south-east England with culture-proven TB were identified from January 1996 to June 1999. Case-notes were reviewed retrospectively.ResultsPatients (n = 188) were severely immunocompromised with a median CD4 cell count at TB diagnosis of 90 × 106cells/l (IQR: 30–180). At presentation, 85% (n = 159) were not taking antiretrovirals. A total of 45% commenced HAART during TB treatment, which was associated with significant reductions in viral load, AIDS-defining illness (ADI) [3.5 versus 24.5%; relative risk (RR) = 0.14] and mortality. Only nine of 91 (10%) patients with a CD4 count > 100 × 106cells/l at TB diagnosis experienced a further ADI, whereas 18 of 92 (20%) patients with a CD4 count < 100 × 106cells/l developed this complication. Adverse events (AE) occurred in 99 (54%) of 183 patients, one-third of whom changed or interrupted HIV and/or TB medication. The majority of AE occurred within the first 2 months, with peripheral neuropathy (21%), rash (17%) and gastrointestinal upset (10%) occurring most commonly.ConclusionsMany physicians delay HAART in patients presenting with TB because of pill burden, drug/drug interactions and toxicity. Although the use of HAART led to significant reductions in viral load, ADI and mortality, co-infected patients commonly experienced AE leading to interruptions in TB/HIV therapy. We therefore recommend starting HAART early for patients with advanced HIV disease (CD4 < 100 × 106cells/l) and deferring HAART until the continuation phase of TB therapy (i.e. after 2 months) for patients who are clinically stable (CD4 > 100 × 106cells/l).
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