AEGiS-15IAC: Antiretroviral therapy in advanced HIV-infected patients with active tuberculosis.

15th International AIDS Conference

Bangkok, Thailand - July 11-16, 2004

Antiretroviral therapy in advanced HIV-infected patients with active tuberculosis.

Int Conf AIDS 2004 Jul 11-16; 15:(abstract no. MoOrB1015)

Sungkanuparph S, Manosuthi W, Kiertiburanakul S, Vibhagool A
Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand

BACKGROUND: Tuberculosis (TB) is a common presentation in advanced HIV-infected patients in developing countries. In addition to treatment of TB, antiretroviral therapy (ART) is indicated. Data regarding timing of ART initiation and treatment outcomes of HIV and TB is limited.

METHODS: A retrospective study was conducted in HIV-infected patients who presented with active TB and had CD4<200 cells/muL. Treatment of TB, ART, and treatment outcomes of HIV and TB were studied.

RESULTS: There were 23 patients (15 males) with a mean age of 37.2 years. Mean CD4 was 61.2 cells/muL and 65.2% had HIV RNA >100000 copies/mL. Site of TB were: lung 69.6%, lymph node 26.1%, and GI tract 4.3%. All patients had first received 4 antituberculous drugs (isoniazid, rifampicin, ethambutol, and pyrazinamide) and PCP prophylaxis. ART was initiated at a median of 8 weeks (range, 4-12) of TB treatment. All patients received NNRTI-based regimens (efavirenz (EFV) 56.5%, nevirapine (NVP) 43.5%). In EFV group, standard short-course TB regimen was used and EFV was increased to 800 mg/day in 2 patients who had body weight >60 kg. In NVP group, TB drugs were switched to a regimen without rifampicin. The duration of TB treatment was 24-32 weeks in EFV group and 32-48 weeks in NVP group. Two patients could not tolerate rifampicin and need substitution with ofloxacin. All patients had clinical improvement of TB. Mean CD4 at 12, 24, 36, and 48 weeks were 99.6, 156.6, 189.5, 185.0 cells/muL, respe ctively. Percentage of patients with HIV RNA<400 and<50 copies/mL at 48 weeks were 78.3% and 82.6%, respectively. There was neither occurrence of new OI or relapse of TB in 48-week follow-up.

CONCLUSIONS: Initiation of ART with NNRTI-based regimen at 8 weeks of antituberculous therapy in advanced HIV-infected patients is safe and effective, and should not be delayed. Further prospective clinical study for the best timing of ART initiation is needed.

Keywords: AEGIS, Acquired Immunodeficiency Syndrome, HIV Seropositivity, Nevirapine, Tuberculosis, Antiretroviral Therapy, Highly Active, Oxazines, Rifampin, Isoniazid, Drug Therapy, Combination, Retrospective Studies, efavirenz, Humans, Male, therapy, drug therapy

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MoOrB1015