Document Detail

Nevirapine-based antiretroviral therapy started early in the course of tuberculosis treatment in adult Malawians.
MedLine Citation:
PMID:  17668560     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: The tuberculosis (TB) mortality rate of registered TB patients in Malawi is 23%, and 59% of the deaths occur in the first 2 months of treatment. HIV-related complications appear to be an important cause. Starting antiretroviral therapy early during tuberculosis treatment may improve outcome but problems often arise with drug interactions, adherence, toxicity and immune reconstitution disease (IRD). METHODS: We prospectively followed 27 HIV-infected adult Malawians after starting Triomune (a generic fixed drug combination of stavudine, lamivudine and nevirapine) in the second week of tuberculosis treatment. RESULTS: At baseline, 88% had CD4+ T-cell counts <100 cells/ml, all were anaemic and 78% were malnourished. Five patients (19%) died, two withdrew consent and one stopped all drugs due to hepatitis. At 6 months, all but one of the 19 remaining patients had good virological results (16 patients: <400 copies/ml, two patients: <1,000 copies/ml) and the median CD4+ T cell increase was 170 cells/ml. Adverse events were numerous, particularly in the first 2 months. Suspected IRD episodes could be managed without treatment interruptions. During the lead-in phase, 59% of nevirapine plasma levels were sub-therapeutic despite good adherence, compared with only 14% during weeks 4 and 8. CONCLUSION: It is feasible to start Triomune early during TB treatment with good treatment outcome. The nevirapine lead-in phase should be avoided when rifampicin-based tuberculosis treatment is started >1 week beforehand.
Joep J G van Oosterhout; Johnstone J Kumwenda; Michael Beadsworth; Gabriel Mateyu; Temba Longwe; David M Burger; Eduard E Zijlstra
Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Antiviral therapy     Volume:  12     ISSN:  1359-6535     ISO Abbreviation:  Antivir. Ther. (Lond.)     Publication Date:  2007  
Date Detail:
Created Date:  2007-08-02     Completed Date:  2008-03-03     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9815705     Medline TA:  Antivir Ther     Country:  England    
Other Details:
Languages:  eng     Pagination:  515-21     Citation Subset:  IM    
University of Malawi College of Medicine, Department of Medicine, Malawi.
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MeSH Terms
AIDS-Related Opportunistic Infections / drug therapy,  microbiology
Anti-HIV Agents / administration & dosage*,  therapeutic use
Antitubercular Agents / administration & dosage*,  therapeutic use
Drug Administration Schedule
Drug Therapy, Combination
HIV Infections / complications,  drug therapy
HIV-1 / drug effects,  physiology
Lamivudine / administration & dosage,  therapeutic use
Middle Aged
Nevirapine / administration & dosage*,  therapeutic use
Reverse Transcriptase Inhibitors / administration & dosage*,  therapeutic use
Rifampin / administration & dosage*,  therapeutic use
Stavudine / administration & dosage,  therapeutic use
Treatment Outcome
Tuberculosis / complications,  drug therapy
Reg. No./Substance:
0/Anti-HIV Agents; 0/Antitubercular Agents; 0/Reverse Transcriptase Inhibitors; 129618-40-2/Nevirapine; 13292-46-1/Rifampin; 134678-17-4/Lamivudine; 3056-17-5/Stavudine

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