Early (2 weeks) vs. late (8 weeks) initiation of highly active antiretroviral treatment (HAART) significantly enhance survival of severely immunosuppressed HIV-infected adults with newly diagnosed tuberculosis: results of the CAMELIA clinical trial

Blanc, F.–X.; Thim, Sok; Laureillard, Didier; Borand, Laurence; Rekacewicz, Claire; Nerrienet, Eric; Madec, Yoann; Marcy, Olivier; Chan, Samleng; Prak, Narom; Kim, Chindamony; Lak, Khemarin Kim; Hak, Chanroeurn; Dim, Bunnet; Sin, Chhun Im; Sath, Sun; Guillard, Bertrand; Sar, Borann; Vong, Sirenda; Fernandez, Marcelo; Fox, Lawrence; Delfraissy, Jean‐François; Goldfeld, Anne E.

doi:10.1186/1753-6561-5-s1-o11

Cited by 51 publications

(66 citation statements)

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“…It was consequently encouraging that the median referral delay decreased over time from 3 months to 1 month. However, even a 1-month referral delay is undesirable 19 and integrated systems of care are required to reduce this further.…”

Section: Discussionmentioning

confidence: 99%

Provider-initiated HIV testing increases access of patients with HIV-associated tuberculosis to antiretroviral treatment

Lawn

Fraenzel²,

Kranzer³

et al. 2011

S Afr Med J

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Section: Discussionmentioning

confidence: 99%

Provider-initiated HIV testing increases access of patients with HIV-associated tuberculosis to antiretroviral treatment

Lawn

Fraenzel²,

Kranzer³

et al. 2011

S Afr Med J

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“…Recent studies have demonstrated that starting ART during treatment for TB reduces mortality in ART-naïve patients despite the increased risk of TB-IRIS (3,22,75,142,266). Observational data from South Africa revealed that 71% of deaths in TB-HIV-coinfected patients on TB treatment occurred in patients waiting to start ART who had CD4 counts of less than 100 cells/l or WHO stage 4 disease (157).…”

Section: Timing Of Initiation Of Antiretrovirals During Treatment Formentioning

confidence: 99%

HIV and Tuberculosis: a Deadly Human Syndemic

2011

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SUMMARY A syndemic is defined as the convergence of two or more diseases that act synergistically to magnify the burden of disease. The intersection and syndemic interaction between the human immunodeficiency virus (HIV) and tuberculosis (TB) epidemics have had deadly consequences around the world. Without adequate control of the TB-HIV syndemic, the long-term TB elimination target set for 2050 will not be reached. There is an urgent need for additional resources and novel approaches for the diagnosis, treatment, and prevention of both HIV and TB. Moreover, multidisciplinary approaches that consider HIV and TB together, rather than as separate problems and diseases, will be necessary to prevent further worsening of the HIV-TB syndemic. This review examines current knowledge of the state and impact of the HIV-TB syndemic and reviews the epidemiological, clinical, cellular, and molecular interactions between HIV and TB.

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“…Early recommendations for a long delay in initiating ART in TB patients to avoid immune reconstitution syndrome have proven largely unfounded, as research has demonstrated that early initiation of ART among coinfected patients reduces mortality [5][6][7][8][9]. This heightens the operational importance of integrated TB/HIV services.…”

Section: Introductionmentioning

confidence: 99%

“…Integrated care was shown to increase ART initiation by 60 % among co-infected patients, reducing time to initiation by more than 2 months (72 days) on average [10]. Randomized trials have shown that early ART initiation (2 weeks after the onset of anti-TB treatment) vs later ART initiation (8 weeks after) reduces mortality among advanced immunodeficient (B50 CD4 cells/mm 3 ) HIVpositive patients who are smear positive for acid-fast bacilli [5,6,9]. Havlir et al [7] showed in TB/HIV co-infected patients with low CD4 cell counts (\50 CD4 cells/mm 3 ) that earlier ART (within 2 weeks after TB treatment initiation) significantly reduced new AIDS-defining illnesses, such as extra-pulmonary tuberculosis, and death compared with late initiation (8-12 weeks after initiating TB treatment).…”

Section: Introductionmentioning

confidence: 99%

Impact of Integrating HIV and TB Care and Treatment in a Regional Tuberculosis Hospital in Rural Guatemala

Ikeda¹,

Tellez²,

Hudes

et al. 2013

AIDS Behav

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Resource-limited settings have made slow progress in integrating TB and HIV care for co-infected patients. We examined the impact of integrated TB/HIV care on clinical and survival outcomes in rural western Guatemala. Prospective data from 254 newly diagnosed TB/HIV patients (99 enrolled in the pre-integrated program from August 2005 to July 2006, and 155 enrolled in the integrated program from February 2008 to January 2009) showed no significant baseline differences between clients in the two periods. They were principally male (65.5 %), Mayan (71 %), median age 33 years, and CD4 count averaged 111 cells/mm 3 . TB/HIV co-infected patients were more likely to receive antiretroviral therapy in the integrated program than in the pre-integrated program (72 vs. 22 %, respectively) and had lower mortality (HR 0.22, 95 % CI 0.14-0.33). This study shows how using a TB setting as the entry point for integrated TB/HIV care can improve health outcomes for HIV-positive patients in rural Guatemala.Resumen Países en vía de desarrollo con recursos limitados han avanzado lentamente en la integración de los programas de TB y VIH para los pacientes co-infectados. Hemos examinado el impacto de la integración de la atención integral del TB/VIH sobre los resultados clínicos y de la sobrevivencia en área rural de Occidente de Guatemala. Datos prospectivos de 254 nuevos casos de infección de TB/ VIH (99 reclutados entre agosto 2005 a julio 2006 en el programa pre-integrado y 155 reclutados entre febrero de 2008 a enero del 2009 en el programa integrado), no mostraron diferencias significativas en la línea basal entre los clientes de los programas en los dos periodos. Estos eran principalmente varones (65.5 %), maya (71 %), promedio de edad fue de 33 años, y el recuento de CD4 al inicio del estudio fue de 111 células/mm 3 . Los pacientes en el programa TB/VIH integrado comparado a los pacientes en el programa pre-integrado eran más probables para recibir terapia antirretroviral (72 % vs. 22 %, respectivamente) y tuvieron menos riesgo de mortalidad (HR 0.22, 95 % CI 0.14-0.33). Este estudio mostró cómo la clínica de TB fue el punto de entrada para proporcionar un programa de atención integral de TB/VIH y ha logrado un mejor resultado de salud para pacientes con el VIH en el área rural de Guatemala.

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Early (2 weeks) vs. late (8 weeks) initiation of highly active antiretroviral treatment (HAART) significantly enhance survival of severely immunosuppressed HIV-infected adults with newly diagnosed tuberculosis: results of the CAMELIA clinical trial

Cited by 51 publications

References 0 publications

Provider-initiated HIV testing increases access of patients with HIV-associated tuberculosis to antiretroviral treatment

Provider-initiated HIV testing increases access of patients with HIV-associated tuberculosis to antiretroviral treatment

HIV and Tuberculosis: a Deadly Human Syndemic

Impact of Integrating HIV and TB Care and Treatment in a Regional Tuberculosis Hospital in Rural Guatemala

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