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AIDS: Anti-TB Therapy Lowers Effectiveness of HIV Therapy

In South Africa, virological failure occurs twice as often in tuberculosis patients who start nevirapine

MONDAY, Aug. 4 (HealthDay News) -- In developing countries, HIV patients who receive rifampicin-based anti-tuberculosis therapy are more likely to experience virological failure after starting nevirapine-based antiretroviral therapy than those who start the more costly efavirenz-based antiretroviral therapy, according to a report published in the Aug. 6 issue of the Journal of the American Medical Association and presented at AIDS 2008, the International AIDS Conference held Aug 3 to 8 in Mexico City.

Andrew Boulle, of the University of Cape Town in South Africa, and colleagues analyzed clinical data on 1,935 subjects who started antiretroviral therapy with nevirapine (including 209 with tuberculosis) and 2,035 subjects who started antiretroviral therapy with efavirenz (including 1,074 with tuberculosis).

After six months of follow-up, the researchers found that elevated viral loads were about twice as common among patients with tuberculosis initiating nevirapine than among those without tuberculosis (16.3 percent versus 8.3 percent). They also found that there was no difference in the rates of elevated viral loads between patients starting efavirenz with and without tuberculosis treatment, or in the rates of patients developing tuberculosis while on nevirapine or efavirenz compared to those free of tuberculosis on the same antiretroviral drug.

"Given the continued reliance on nevirapine-containing antiretroviral therapy regimens in Africa, together with the important role tuberculosis services play as an entry point for antiretroviral therapy, further prospective studies exploring this outcome are warranted," the authors write. "One of the most striking aspects of our study was the demonstration that 40 percent of patients starting antiretroviral therapy in recent years have concurrent tuberculosis, underscoring the public health importance of improving affordable treatment options for patients infected with HIV and tuberculosis in this setting."

One of the authors reported receiving a speakers honorarium from Merck, Sharp & Dohme South Africa.

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