Early Initiation of ART After TB Treatment Ups Survival

Risk of death reduced for patients with a CD4+ T-cell count of less than 50 per cubic millimeter

WEDNESDAY, Oct. 19 (HealthDay News) -- For patients with HIV and tuberculosis, initiation of antiretroviral therapy (ART) early after starting tuberculosis treatment improves survival in those with CD4+ T-cell counts of less than 50/mm³, according to three studies published in the Oct. 20 issue of the New England Journal of Medicine.

Francois-Xavier Blanc, M.D., Ph.D., from Bicêtre Hospital in Le Kremlin-Bicêtre, France, and colleagues investigated whether the timing of ART initiation affects mortality in antiretroviral-naive adults with newly diagnosed tuberculosis. Patients were randomized to ART two (earlier) or eight (later) weeks after starting tuberculosis treatment. The median CD4+ T-cell count was 25/mm³. The risk of death was significantly reduced in the earlier treatment group compared to the later group (hazard ratio, 0.62).

In a second study, Diane V. Havlir, M.D., from the University of California in San Francisco, and colleagues compared earlier and later ART in HIV-1 infected patients with CD4" T-cell counts of less than 250/mm³ and suspected tuberculosis. For patients with a median baseline CD4+ T-cell count of less than 50 per cubic millimeter, significantly fewer patients died in the earlier versus later groups (15.5 versus 26.6 percent). In a third study, Salim S. Abdool Karim, M.B., Ch.B., Ph.D., from the Center for AIDS Programme of Research in Durban, South Africa, and colleagues found that early initiation of ART (within four weeks of the start of tuberculosis treatment) in patients with CD" T-cell counts of less than 50/mm³ increased AIDS-free survival.

"We found that early initiation of ART in patients with CD4+ T-cell counts of less than 50 per cubic millimeter increased AIDS-free survival," Abdool Karim and colleagues write.

One author from the Blanc study disclosed financial ties to the pharmaceutical industry. The Havlir study was funded by Gilead Sciences and Merck Pharmaceuticals.

Abstract - Blanc
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Abstract - Havlir
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Abstract - Abdool Karim
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