Safety and effectiveness of HAART in tuberculosis-HIV co-infected patients in Brazil

Abstract

SUMMARY BACKGROUND Antiretroviral therapy (ART) significantly reduces tuberculosis (TB) incidence among persons with human immunodeficiency virus (HIV), but the safety and effectiveness of concomitant treatment for both diseases remain unclear. OBJECTIVE To evaluate the impact of ART and anti-tuberculosis treatment on survival and risk of adverse events (AE) among co-infected individuals. METHODS In a retrospective cohort study, clinical data were collected from 618 TB-HIV patients treated with rifampin, isoniazid and pyrazinamide ± ethambutol between 1 January 1995 and 31 December 2003. Patients were categorized into two groups: highly active ART (HAART) or no ART. Different HAART regimens were evaluated. Bivariate analysis, multivariate logistic regression and survival analysis using Cox proportional hazards regression were used. RESULTS One-year mortality was lower for patients receiving HAART (adjusted hazard ratio [aHR] 0.17, 95%CI 0.09–0.31) compared to no ART. HAART increased the risk of AE (aHR 2.08, 95%CI 1.29–3.36). The odds of AE when receiving a ritonavir + saquinavir HAART regimen was eight-fold higher compared to no ART (OR 8.31, 95%CI 3.04–22.69), while efavirenz-based HAART was not associated with a significantly increased risk of AE (OR 1.42, 95%CI 0.76–2.65). CONCLUSION HIV patients with TB have significantly better survival if they receive HAART during anti-tuberculosis treatment. Efavirenz-based HAART is associated with fewer AEs than protease inhibitor-based HAART.

Trends of Tuberculosis Case Notification and Treatment Outcomes in the Sidama Zone, Southern Ethiopia: Ten-Year Retrospective Trend Analysis in Urban-Rural Settings

“…Studies reported more PTB- cases among HIV-infected individuals [36] , [46] , while previous studies from southern Ethiopia also reported a high TB-HIV co-infection, with the rate of HIV infection among PTB- cases being 18–26% [36] , [37] . The declining trend in mortality during treatment in our study may be explained in part by ART services because ART reduces deaths in TB cases infected with HIV [47] . In recent years, there has been an increase in both ART centers and the number of patients starting ART in the study area [24] .The number of ART centers in the study area increased from one to 20 during the study period.…”

The Impact of Antiretroviral Therapy on Mortality in HIV Positive People during Tuberculosis Treatment: A Systematic Review and Meta-Analysis

“…The characteristics of the included studies are reported in Table 1 . The majority of the studies were conducted in the African (n = 11, 52%) [14] , [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] and South-East Asian (n = 7, 33%) [33] , [34] , [35] , [36] , [37] , [38] , [39] regions; two studies were conducted in South America [40] , [41] and one in Europe [42] . Four out of seven studies in the South-East Asian region were conducted in Thailand [33] , [35] , [37] , [38] while one used data from eighteen sites in the Asia-Pacific region [39] .…”

Tuberculosis among HIV-infected patients in Stockholm, Sweden, 1987–2010: Treatment outcomes and adverse reactions

“…The main interactions are between the anti-TB drugs rifampicin and rifabutin and antiretroviral drugs, in particular PIs (Baciewicz, Chrisman, Finch, & Self, 2008). Patients on combined treatment have an increased risk of adverse events (Dos Santos et al, 2013;Dean et al, 2002).…”

“…In the current Swedish national guidelines for HIV treatment, PI-based cART is a recommended first-line alternative after the NNRTI efavirenz, in combination with anti-TB treatment (Referensgruppen för antiviral terapi, 2014). The most common cART in the study setting was PI-based, which has been associated with a higher risk of adverse reactions than efavirenz-based cART (Dos Santos et al, 2013).…”