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...

Full description

Saved in:
Bibliographic Details
Published in:The New England journal of medicine Vol. 365; no. 16; pp. 1471 - 1481
Main Authors: 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
Format: Journal Article
Language:English
Published: Waltham, MA Massachusetts Medical Society 20.10.2011
Subjects:
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
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary: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 . . .
Bibliography: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