OBJECTIVE: To provide information on the effect of timing of antiretroviral therapy (ART) initiation on outcomes of TB infection in real-life, non-clinical trial, rural settings in sub-Saharan Africa. METHODS: We conducted an observational cohort study of all HIV-infected TB patients presenting to a rural hospital in Kenya between 2005 and 2009. We analysed the association between timing of initiation of ART and mortality, using a Cox regression survival analysis, adjusted for measured confounders. RESULTS: A total of 404 antiretroviral-naïve HIV/TB coinfected patients were included in the study. Initiation of ART during the first 8 weeks of TB treatment (early group) was not associated with changes in mortality at 1 year compared with initiation of ART after 8 weeks (late group) [Hazard Ratio (HR) = 0.74 (Confidence Interval (CI), 0.33-1.64, P = 0.46]. In patients with baseline CD4 counts ≤50 cells/μl, there was a significant reduction in mortality in the early group compared with the late group (HR = 0.20; 95% CI, 0.042-0.99; P = 0.049). In patients with a CD4 count >50 cells/μl, there was no significant difference between early and late groups (HR 1.79; 95% CI, 0.64-5.03; P = 0.27). CONCLUSIONS: We found that in HIV/TB coinfected patients in rural Kenya, early ART initiation (within 8 weeks) was associated with reduced mortality in those with CD4 counts ≤50 cells/μl. In patients with CD4 counts >50 cells/μl, there was no association seen between timing of ART and mortality.
OBJECTIVE: To provide information on the effect of timing of antiretroviral therapy (ART) initiation on outcomes of TB infection in real-life, non-clinical trial, rural settings in sub-Saharan Africa. METHODS: We conducted an observational cohort study of all HIV-infected TBpatients presenting to a rural hospital in Kenya between 2005 and 2009. We analysed the association between timing of initiation of ART and mortality, using a Cox regression survival analysis, adjusted for measured confounders. RESULTS: A total of 404 antiretroviral-naïve HIV/TB coinfectedpatients were included in the study. Initiation of ART during the first 8 weeks of TB treatment (early group) was not associated with changes in mortality at 1 year compared with initiation of ART after 8 weeks (late group) [Hazard Ratio (HR) = 0.74 (Confidence Interval (CI), 0.33-1.64, P = 0.46]. In patients with baseline CD4 counts ≤50 cells/μl, there was a significant reduction in mortality in the early group compared with the late group (HR = 0.20; 95% CI, 0.042-0.99; P = 0.049). In patients with a CD4 count >50 cells/μl, there was no significant difference between early and late groups (HR 1.79; 95% CI, 0.64-5.03; P = 0.27). CONCLUSIONS: We found that in HIV/TB coinfectedpatients in rural Kenya, early ART initiation (within 8 weeks) was associated with reduced mortality in those with CD4 counts ≤50 cells/μl. In patients with CD4 counts >50 cells/μl, there was no association seen between timing of ART and mortality.
Authors: Maria Velasco; Virgilio Castilla; José Sanz; Gabriel Gaspar; Emilia Condes; Carlos Barros; Miguel Cervero; Rafael Torres; Carlos Guijarro Journal: J Acquir Immune Defic Syndr Date: 2009-02-01 Impact factor: 3.731
Authors: J A Scott; A J Hall; C Muyodi; B Lowe; M Ross; B Chohan; K Mandaliya; E Getambu; F Gleeson; F Drobniewski; K Marsh Journal: Lancet Date: 2000-04-08 Impact factor: 79.321
Authors: Diana S Pope; Andrea N Deluca; Paula Kali; Harry Hausler; Carol Sheard; Ebrahim Hoosain; Mohammad A Chaudhary; David D Celentano; Richard E Chaisson Journal: J Acquir Immune Defic Syndr Date: 2008-06-01 Impact factor: 3.731