| published 24-10-2007
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When should antiretroviral treatment be started in patients with both tuberculosis and HIV infections? There are many considerations including the pill burden, possible drug reactions, drug interactions, immune reconstitution syndrome, and so on. This prospective study looked at a cohort of 329 coinfected patients and examined their survival according to when ARTs were begun. After adjusting for other variables, there was a strong improved probability of survival in the patients who began ART early.
Abstract
Antiretroviral therapy (ART) is lifesaving in patients with advanced HIV infection, but the magnitude of benefit in HIV-infected patients receiving tuberculosis (TB) treatment remains uncertain, and population-based data from developing countries are limited. We prospectively collected data about HIV-infected TB patients from February 2003 through January 2004 in Ubon-ratchathani, Thailand. During 12 months, HIV was diagnosed in 329 (14%) of 2,342 patients registered for TB treatment. Of patients with known outcomes, death during TB treatment occurred in 5 (7%) of 71 who received ART and 94 (43%) of 219 who did not. Using multivariate analysis, we found a large reduction in the odds of death for patients receiving ART before or during TB treatment (odds ratio, 0.2; 95% confidence interval, 0.1–0.5), adjusting for CD4 count, smear status, co-trimoxazole use, and treatment facility. ART is associated with a substantial reduction in deaths during TB treatment for HIV-infected TB patients in Thailand.
Akksilp S, Karnkawinpong O, Wattanaamornkiat W, Viriyakitja D, Monkongdee P, Sitti W, et al. Antiretroviral therapy during tuberculosis treatment and marked reduction in death rate of HIV-infected patients, Thailand. Emerg Infect Dis [serial on the Internet]. 2007 Jul [date cited]. Available from http://www.cdc.gov/EID/content/13/7/1001.htm. Free full text.
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