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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Bibliographic Details
Published in:The New England journal of medicine Vol. 365; no. 16; pp. 1482 - 1491
Main Authors: 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
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 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
Online Access:Get full text
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Summary: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. . . .
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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