Antiretroviral treatment in TB patients: patients with CD4 counts below 50 need to start ART quickly
Starting HIV treatment within two weeks of HIV treatment is most necessary in patients with CD4 counts below 50, while a slightly longer delay does not appear to be harmful for those with less advanced disease, two large international trials have shown.
One study also found that starting HIV treatment around three months after starting antiretroviral treatment resulted in fewer cases of immune reconstitution inflammatory syndrome (IRIS) when compared to starting antiretroviral treatment within two weeks of TB treatment initiation.
The findings were reported on the opening day of the Eighteenth Conference on Retroviruses in Boston.
The results confirm and extend the results of the CAMELIA trial, reported last year at the Eighteenth International AIDS Conference in Vienna, which showed that immediate antiretroviral treatment reduced the risk of death in TB patients by one-third when compared to waiting for eight weeks in a population of Cambodian patients with a median CD4 count of 25 cells/mm3.
The high burden of TB in people with HIV infection means that decision-making about when to start antiretroviral treatment is a critical part of HIV care in many settings. Many clinicians have expressed concern about the risk of IRIS in patients with TB if antiretroviral treatment is started before TB is cured.
There have also been concerns about the use of antiretroviral drugs alongside the four-drug intensive phase of TB treatment, which usually lasts for the first eight weeks of TB treatment.
However in 2009 the World Health Organization issued new guidelines recommending that antiretroviral therapy should be started as soon as possible after starting TB treatment in coinfected patients.
The studies presented today shed further light one the question of how soon treatment needs to start, although the findings are likely to be of greater relevance in settings where CD4 counts are available to guide decision-making.
Similar Posts:
- Only modest benefits from starting HIV therapy with a CD4 cell count above 500 compared to 350
- Watch for malnutrition risk in children with HIV after starting ART
- Zambian study shows importance of early HIV test and fast ART for pregnant women
- Viral load monitoring of ART patients linked to lower death rate on treatment in southern Africa
- HIV treatment in primary infection: 48 week course modestly delays CD4 drop
