Document Detail

When to start antiretroviral therapy during tuberculosis treatment?
MedLine Citation:
PMID:  23188213     Owner:  NLM     Status:  MEDLINE    
PURPOSE OF REVIEW: Effective treatment exists for tuberculosis (TB) and for HIV, but treating both diseases simultaneously presents several challenges. This review assesses the evidence for the timing of antiretroviral therapy (ART) initiation in patients coinfected with TB.
RECENT FINDINGS: Published evidence clearly demonstrates that TB-HIV integration is essential for improved survival, but the question of when to start ART during TB treatment is more complex. Five randomized controlled trials assessed this question: four trials showed no difference in the incidence rates of AIDS or death between TB patients initiating ART within 2 months compared to later during TB therapy, while one trial showed a significant survival gain with ART initiation within 2 weeks of TB therapy start. All five studies found improved AIDS-free survival with earlier ART initiation in TB patients with low CD4 T-cell counts, except among patients with TB meningitis. The survival benefit was, however, accompanied by increased immune reconstitution inflammatory syndrome events.
SUMMARY: The trial data support the World Health Organization recommendations on when to start ART in TB-HIV coinfected patients including earlier ART initiation in severely immune-compromised patients. However, several challenges remain in integrating TB and HIV treatment in public healthcare services. Additional research on timing of ART is needed for patients with drug-resistant and extrapulmonary TB, notably TB meningitis.
Kogieleum Naidoo; Cheryl Baxter; Salim S Abdool Karim
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Current opinion in infectious diseases     Volume:  26     ISSN:  1473-6527     ISO Abbreviation:  Curr. Opin. Infect. Dis.     Publication Date:  2013 Feb 
Date Detail:
Created Date:  2012-12-17     Completed Date:  2013-05-20     Revised Date:  2014-02-04    
Medline Journal Info:
Nlm Unique ID:  8809878     Medline TA:  Curr Opin Infect Dis     Country:  United States    
Other Details:
Languages:  eng     Pagination:  35-42     Citation Subset:  IM    
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MeSH Terms
AIDS-Related Opportunistic Infections / drug therapy*
Anti-Retroviral Agents / therapeutic use*
CD4-Positive T-Lymphocytes
Coinfection / drug therapy*
Disease-Free Survival
Drug Administration Schedule
HIV Infections / drug therapy*,  immunology
Randomized Controlled Trials as Topic
Tuberculosis / drug therapy*,  immunology
Grant Support
Reg. No./Substance:
0/Anti-Retroviral Agents

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