Earlier versus Later Start of Antiretroviral Therapy in HIV-Infected Adults with Tuberculosis

When to initiate antiretroviral therapy in patients with newly diagnosed HIV infection and TB has been debated. In this study from Cambodia, giving antiretrovirals 2 weeks after the start of TB therapy was superior to therapy begun at 8 weeks, with a decrease in mortality. Tuberculosis is a major ca...

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Vydáno v:	The New England journal of medicine Ročník 365; číslo 16; s. 1471 - 1481
Hlavní autoři:	Blanc, François-Xavier, Sok, Thim, Laureillard, Didier, Borand, Laurence, Rekacewicz, Claire, Nerrienet, Eric, Madec, Yoann, Marcy, Olivier, Chan, Sarin, Prak, Narom, Kim, Chindamony, Lak, Khemarin Kim, Hak, Chanroeurn, Dim, Bunnet, Sin, Chhun Im, Sun, Sath, Guillard, Bertrand, Sar, Borann, Vong, Sirenda, Fernandez, Marcelo, Fox, Lawrence, Delfraissy, Jean-François, Goldfeld, Anne E
Médium:	Journal Article
Jazyk:	angličtina
Vydáno:	Waltham, MA Massachusetts Medical Society 20.10.2011
Témata:	Acquired immune deficiency syndrome Adult AIDS AIDS-Related Opportunistic Infections - drug therapy Anti-Retroviral Agents - administration & dosage Anti-Retroviral Agents - adverse effects Antibiotics. Antiinfectious agents. Antiparasitic agents Antiretroviral agents Antiretroviral drugs Antiretroviral therapy Antitubercular Agents - therapeutic use Antiviral agents Biological and medical sciences CD4 antigen CD4 Lymphocyte Count Drug Administration Schedule Drug therapy Efavirenz Female Follow-Up Studies General aspects Hepatitis HIV HIV Infections - complications HIV Infections - drug therapy HIV Infections - mortality Human health and pathology Human immunodeficiency virus Human viral diseases Humans Immune reconstitution Immunosuppressive agents Infectious diseases Inflammation Kaplan-Meier Estimate Lamivudine Life Sciences Lymphocytes T Male Medical sciences Mortality Patients Pharmaceutical sciences Pharmacology Pharmacology. Drug treatments Santé publique et épidémiologie Stavudine Tuberculosis Tuberculosis - complications Tuberculosis - drug therapy Viral diseases Viral diseases of the lymphoid tissue and the blood. Aids Viral Load Human Immunopathology Antiretroviral agent AIDS Mycobacterial infection Immune deficiency Infection Medicine Chemotherapy Treatment Tuberculosis Viral disease Bacteriosis Adult Antiviral Comparative study
ISSN:	0028-4793, 1533-4406, 1533-4406
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Popis
Shrnutí:	When to initiate antiretroviral therapy in patients with newly diagnosed HIV infection and TB has been debated. In this study from Cambodia, giving antiretrovirals 2 weeks after the start of TB therapy was superior to therapy begun at 8 weeks, with a decrease in mortality. Tuberculosis is a major cause of death in persons infected with the human immunodeficiency virus (HIV), especially in resource-limited settings. 1 , 2 Despite effective tuberculosis therapy, mortality is particularly high among patients with severe immunosuppression. 3 , 4 Although mortality among HIV-infected patients has been reported to be approximately 30% within the first 2 months of tuberculosis treatment if antiretroviral therapy (ART) is withheld, 5 the timing for starting ART in patients with tuberculosis has remained unclear. Arguments that support delayed initiation of ART include concern about the combined toxic effects of drugs, an increased risk of the immune reconstitution inflammatory syndrome (IRIS), and . . .
Bibliografie:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 14 content type line 23 ObjectType-Undefined-3 PMCID: PMC4879711 Investigators and members of the CAMELIA (Cambodian Early versus Late Introduction of Antiretrovirals) study team are listed in the Supplementary Appendix, available at NEJM.org. The authors’ affiliations are listed in the Appendix. Drs. Blanc and Sok contributed equally to this article.
ISSN:	0028-4793 1533-4406 1533-4406
DOI:	10.1056/NEJMoa1013911