Document Detail


Outcome of HIV-associated tuberculosis in the era of highly active antiretroviral therapy.
MedLine Citation:
PMID:  15478074     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: The benefit of highly active antiretroviral therapy (HAART) in the treatment of patients coinfected with tuberculosis (TB) and human immunodeficiency virus (HIV) is unclear because of concerns about treatment-related complications. METHODS: We compared outcomes in patients starting TB treatment during the pre-HAART era (before 1996; n=36) with those in patients starting treatment during the HAART era (during or after 1996; n=60). RESULTS: During a median of 3.6 years of follow-up, 49 patients died or had an AIDS event. Compared with patients in the pre-HAART group, those in the HAART group had a lower risk of death (cumulative at 4 years, 43% vs. 22%; P=.012) and of death or having an AIDS event (69% vs. 43%; P=.023). Event risk within the first 2 months of TB treatment was exceptionally high in patients with CD4(+) cell counts <100 cells/mm(3) and declined thereafter. HAART use during follow-up was associated with a marked reduction in event risk (adjusted hazard ratio, 0.38 [95% confidence interval, 0.16-0.91]). CONCLUSIONS: HAART substantially reduces new AIDS events and death in coinfected patients. Those with a CD4(+) cell count <100 cells/mm(3) have a high event risk during the intensive phase of anti-TB treatment. These data should be taken into account when deciding to delay HAART in coinfected patients with CD4(+) cell counts <100 cells/mm(3).
Authors:
Keertan Dheda; Fiona C Lampe; Margaret A Johnson; Marc C Lipman
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Publication Detail:
Type:  Comparative Study; Journal Article     Date:  2004-09-29
Journal Detail:
Title:  The Journal of infectious diseases     Volume:  190     ISSN:  0022-1899     ISO Abbreviation:  J. Infect. Dis.     Publication Date:  2004 Nov 
Date Detail:
Created Date:  2004-10-12     Completed Date:  2004-11-30     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0413675     Medline TA:  J Infect Dis     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1670-6     Citation Subset:  AIM; IM    
Affiliation:
Department of Thoracic and HIV Medicine, Royal Free Hospital, Royal Free and University College London Medical School, London, United Kingdom. k.dheda@ucl.ac.uk.
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MeSH Terms
Descriptor/Qualifier:
AIDS-Related Opportunistic Infections / drug therapy
Adult
Antiretroviral Therapy, Highly Active*
Antitubercular Agents / adverse effects,  therapeutic use*
CD4 Lymphocyte Count
Female
HIV Infections / complications*,  drug therapy*,  mortality
Humans
London
Male
Middle Aged
Risk Assessment
Treatment Outcome
Tuberculosis / complications*,  drug therapy*,  microbiology,  mortality
Chemical
Reg. No./Substance:
0/Antitubercular Agents
Comments/Corrections
Comment In:
J Infect Dis. 2005 Nov 1;192(9):1673-4; author reply 1674-5   [PMID:  16206087 ]

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