Effectiveness of highly active antiretroviral therapy (HAART) used concomitantly with rifampicin in patients with tuberculosis and AIDS

Sant’Anna, Flávia Marinho; Velasque, Luciane; Costa, Maria Alice Nunes; Schmaltz, Carolina Arana Stanis; Morgado, Mariza G.; Lourenço, Maria Cristina da Silva; Grinsztejn, Beatriz; Rolla, Valéria Cavalcanti

doi:10.1590/s1413-86702009000500010

Cited by 4 publications

(5 citation statements)

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“…Adequate plasma concentrations of lopinavir are also achieved in adults by doubling the dose of lopinavir/ritonavir in the tablet formulation (to 800/200 mg twice daily); this is the simplest approach, especially in settings where the separate ritonavir is not available [71]. Although these approaches are associated with high rates of hepatotoxicity in studies of healthy volunteers, these seem to be much safer in HIV infected patients [71-76]. Nevertheless, hepatotoxicity, gastrointestinal side effects and poor tolerability are problematic and treatment discontinuation rates of up to nearly 50% have been reported [74,75].…”

Section: Introductionmentioning

confidence: 99%

Management of HIV-associated tuberculosis in resource-limited settings: a state-of-the-art review

Lawn

Meintjes

McIlleron

et al. 2013

BMC Med

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The HIV-associated tuberculosis (TB) epidemic remains a huge challenge to public health in resource-limited settings. Reducing the nearly 0.5 million deaths that result each year has been identified as a key priority. Major progress has been made over the past 10 years in defining appropriate strategies and policy guidelines for early diagnosis and effective case management. Ascertainment of cases has been improved through a twofold strategy of provider-initiated HIV testing and counseling in TB patients and intensified TB case finding among those living with HIV. Outcomes of rifampicin-based TB treatment are greatly enhanced by concurrent co-trimoxazole prophylaxis and antiretroviral therapy (ART). ART reduces mortality across a spectrum of CD4 counts and randomized controlled trials have defined the optimum time to start ART. Good outcomes can be achieved when combining TB treatment with first-line ART, but use with second-line ART remains challenging due to pharmacokinetic drug interactions and cotoxicity. We review the frequency and spectrum of adverse drug reactions and immune reconstitution inflammatory syndrome (IRIS) resulting from combined treatment, and highlight the challenges of managing HIV-associated drug-resistant TB.

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Section: Introductionmentioning

confidence: 99%

Management of HIV-associated tuberculosis in resource-limited settings: a state-of-the-art review

Lawn

Meintjes

McIlleron

et al. 2013

BMC Med

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“…For that population, the options are use lopinavir boosted with ritonavir (800–200 mg or 400–400 mg) and keep the anti-TB drugs in a fixed dose [24,25] or deconstruction of TB fixed dose combination to use Rifabutin (for those who have it available in the public health units) concomitant to others PIs [8]. Our previous study also revealed that patients treated with PI (in both situations described above) had 3.08 times more risk of treatment failure compared with patients using efavirenz-based ARV regimens [6]. Ritonavir boosted PI regimens are toxic and when added to antitubercular drugs may result in interruption of both therapies; no other ARV regimen compatible with rifampicin is recommended in Brazil for instance.…”

Section: Discussionmentioning

confidence: 99%

“…In 2009, Sant’Anna et al conducted a study in TB-HIV patients to evaluate the HIV VL control after ARV therapy implementation in ARV-naïve (those persons who have never received ARV before) and ARV-experienced patients (those who have used ARV regimens previously) from Rio de Janeiro, Brazil [6]. The authors found that, for ARV-naïve patients, the best results were achieved with efavirenz-based regimens.…”

Section: Introductionmentioning

confidence: 99%

“…The authors found that, for ARV-naïve patients, the best results were achieved with efavirenz-based regimens. However, for ARV-experienced patients, the effectiveness was lower than that found in naïve patients, and efavirenz based regimens were not effective, which was attributed to probable acquired drug resistance [6]. Additional studies in this population revealed that ARV regimens containing a Protease Inhibitor (PI) boosted with ritonavir were associated with better virologic control but also linked to increased incidence of severe adverse reactions [7].…”

Section: Introductionmentioning

confidence: 99%

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Predictors of early mortality and effectiveness of antiretroviral therapy in TB-HIV patients from Brazil

et al. 2019

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Background The implementation of antiretroviral (ARV) therapy caused a significant decrease in HIV-associated mortality worldwide. Nevertheless, mortality is still high among people living with HIV/AIDS and tuberculosis (TB). ARV-naïve HIV patients coinfected with tuberculosis (TB) have more options to treat both diseases concomitantly. Nevertheless, some TB-HIV patients undertaking ARVs (ARV-experienced) are already failing the first line efavirenz-based regimen and seem to display different response to second line ARV therapy and exhibit other predictors of mortality. Methods We performed a retrospective cohort study including 273 patients diagnosed with TB-HIV and treated at a referral center in Rio de Janeiro, Brazil, between 2008 and 2016. Multivariate analysis and Cox regression models were used to evaluate the effectiveness of ARV therapy regimens (viral load [VL] <80 copies from the 4 th to 10 th months after TB therapy introduction) and to identify predictors of early mortality (100 days after TB therapy initiation) considering ARV-naïve and ARV-experienced patients adjusting for sociodemographic, clinical and therapeutic covariates. Findings Survival analysis included 273 patients, out of whom 154 (56.4%) were ARV-naïve and 119 (43.6%) were ARV-experienced. Seven deaths occurred within 6 months of anti-TB treatment, 4 in ARV-naïve and 3 in ARV-experienced patients. Multivariate analysis revealed that in ARV-naïve patients, the chance of death was substantially higher in patients who developed immune reconstitution inflammatory syndrome during the study follow up (HR = 40.6, p<0.01). For ARV-experienced patients, similar analyses failed to identify factors significantly associated with mortality. Variables independently associated with treatment failure for the ARV-naïve group were previous TB (adjusted OR [aOR] = 6.1 p = 0.03) and alcohol abuse (aOR = 3.7 p = 0.01). For ARV-experienced patients, a ritonavir boosted. Protease Inhibitor-based regimen resulted in a 2.6 times higher risk of treatment failure compared to the use of efavirenz based ARV regimens (p = 0.03) and High baseline HIV VL (p = 0.03) were predictors of treatment failure. Conclusions Risk factors for mortality and ARV failure were different for ARV-naïve and ARV-experienced patients. The latter patient group should be targeted for trials with less toxic and rifampicin-compatible drugs to improve TB-HIV treatment outcomes and prevent death.

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“…HAART will rapidly reconstitute the immune surveillance (indicated by elevation of yellow column) (Hua et al, 2011). The occurrence of TB therefore decreases (Sant'Anna et al, 2009). …”

Section: Network Among Ltbi and Hivmentioning

confidence: 99%

Immunological Diagnosis of Active and Latent TB

Shiratori¹,

Saitoh²,

Siddiqi³

et al. 2012

Understanding Tuberculosis - Global Experiences and Innovative Approaches to the Diagnosis

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Effectiveness of highly active antiretroviral therapy (HAART) used concomitantly with rifampicin in patients with tuberculosis and AIDS

Cited by 4 publications

References 11 publications

Management of HIV-associated tuberculosis in resource-limited settings: a state-of-the-art review

Management of HIV-associated tuberculosis in resource-limited settings: a state-of-the-art review

Predictors of early mortality and effectiveness of antiretroviral therapy in TB-HIV patients from Brazil

Immunological Diagnosis of Active and Latent TB

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