Timing of Antiretroviral Therapy for HIV-1 Infection and Tuberculosis

In this international study involving 809 patients with HIV and TB coinfection, earlier therapy for both infections, versus waiting 8 to 12 weeks to initiate antiretrovirals after anti-TB therapy, was beneficial in patients with a low CD4+ T-cell count (<50 per cubic millimeter). The treatment of...

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Veröffentlicht in:	The New England journal of medicine Jg. 365; H. 16; S. 1482 - 1491
Hauptverfasser:	Havlir, Diane V, Kendall, Michelle A, Ive, Prudence, Kumwenda, Johnstone, Swindells, Susan, Qasba, Sarojini S, Luetkemeyer, Anne F, Hogg, Evelyn, Rooney, James F, Wu, Xingye, Hosseinipour, Mina C, Lalloo, Umesh, Veloso, Valdilea G, Some, Fatuma F, Kumarasamy, N, Padayatchi, Nesri, Santos, Breno R, Reid, Stewart, Hakim, James, Mohapi, Lerato, Mugyenyi, Peter, Sanchez, Alejandro, Sanchez, Jorge, Lama, Javier R, Pape, Jean W, Asmelash, Aida, Moko, Evans, Sawe, Fred, Andersen, Janet, Sanne, Ian
Format:	Journal Article
Sprache:	Englisch
Veröffentlicht:	Waltham, MA Massachusetts Medical Society 20.10.2011
Schlagworte:	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 drugs Antiretroviral therapy Antitubercular Agents - therapeutic use Antiviral agents Biological and medical sciences CD4 antigen CD4 Lymphocyte Count Drug Administration Schedule Female General aspects HIV HIV Infections - complications HIV Infections - drug therapy HIV Infections - mortality HIV-1 Human immunodeficiency virus Human viral diseases Humans Immune reconstitution Infectious diseases Inflammation Kaplan-Meier Estimate Laboratories Lymphocytes T Male Medical sciences Mortality Patients Pharmacology. Drug treatments Ribonucleic acid RNA Tuberculosis Tuberculosis - complications Tuberculosis - drug therapy Viral diseases Viral diseases of the lymphoid tissue and the blood. Aids United States > US San Francisco California Immunopathology Antiretroviral agent HIV-1 virus Retroviridae AIDS Mycobacterial infection Immune deficiency Lentivirus Infection Virus Medicine Chemotherapy Treatment Tuberculosis Viral disease Bacteriosis Temporal study Antiviral Human immunodeficiency virus Timing
ISSN:	0028-4793, 1533-4406, 1533-4406
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Zusammenfassung:	In this international study involving 809 patients with HIV and TB coinfection, earlier therapy for both infections, versus waiting 8 to 12 weeks to initiate antiretrovirals after anti-TB therapy, was beneficial in patients with a low CD4+ T-cell count (<50 per cubic millimeter). The treatment of patients with tuberculosis and newly identified infection with human immunodeficiency virus type 1 (HIV-1) is one of the most challenging aspects of HIV medicine. Antiretroviral therapy (ART) must be started during treatment for tuberculosis, 1 , 2 yet starting ART very early in the course of tuberculosis therapy increases the pill burden, the potential drug toxicity, and the risk of tuberculosis-associated immune reconstitution inflammatory syndrome (IRIS). 3 , 4 For these reasons, programs, providers, and patients are reluctant to initiate ART during the intensive 8-week induction phase of tuberculosis therapy, when the pill burden and toxicity of tuberculosis medications are greatest. . . .
Bibliographie:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 14 ObjectType-Article-2 ObjectType-Feature-1 content type line 23 ObjectType-Undefined-3 Authors’ full names and degrees, along with members of the A5221 study team, are listed in the Supplementary Appendix
ISSN:	0028-4793 1533-4406 1533-4406
DOI:	10.1056/NEJMoa1013607