title: Adverse events and treatment interruption in tuberculosis patients with and without HIV co-infection.
abstract: BACKGROUND
  Serious treatment associated adverse events are thought to occur more frequently in individuals with tuberculosis (TB) who are co-infected with HIV. A study was undertaken to assess the frequency of serious (grade III/IV) adverse events and interruption of anti-TB treatment in the era of effective antiretroviral therapy.
  
  
  METHODS
  The incidence of serious adverse events was retrospectively compared in 312 individuals treated for TB, 156 of whom were co-infected with HIV.
  
  
  RESULTS
  111 HIV infected individuals (71%) received highly active antiretroviral therapy at the same time as anti-TB treatment. Serious adverse events were recorded in 40% HIV infected and 26% HIV uninfected individuals (p = 0.008). Peripheral neuropathy and persistent vomiting were more common in co-infected patients (p<0.001; p = 0.006), although all cause interruption of anti-TB treatment occurred with similar frequency in the two groups (13% in HIV infected patients and 15% in HIV uninfected patients; p = 0.74). In 85% of HIV infected patients and 87% of HIV uninfected individuals this was due to hepatotoxicity, which typically presented within 2 months of starting treatment. The median delay in restarting treatment was 4 weeks, so most individuals required full TB re-treatment.
  
  
  CONCLUSIONS
  Despite a greater rate of serious (grade III/IV) adverse events among HIV infected individuals, discontinuation of anti-TB treatment occurred with a similar frequency in HIV infected and HIV uninfected individuals.
authors.affiliation: Department of Thoracic and HIV Medicine, Royal Free Hospital, London, UK. r.breen@medsch.ucl.ac.uk
authors.forename: R A M
authors.initials: RA
authors.lastname: Breen
authors.forename: R F
authors.initials: RF
authors.lastname: Miller
authors.forename: T
authors.initials: T
authors.lastname: Gorsuch
authors.forename: C J
authors.initials: CJ
authors.lastname: Smith
authors.forename: A
authors.initials: A
authors.lastname: Schwenk
authors.forename: W
authors.initials: W
authors.lastname: Holmes
authors.forename: J
authors.initials: J
authors.lastname: Ballinger
authors.forename: L
authors.initials: L
authors.lastname: Swaden
authors.forename: M A
authors.initials: MA
authors.lastname: Johnson
authors.forename: I
authors.initials: I
authors.lastname: Cropley
authors.forename: M C I
authors.initials: MC
authors.lastname: Lipman
mesh_terms: D000328:Adult; D000368:Aged; D023241:Antiretroviral Therapy, Highly Active / Q000009:adverse effects*; D000995:Antitubercular Agents / Q000009:adverse effects*; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014376:Tuberculosis / Q000150:complications / Q000188:drug therapy; D028761:Withholding Treatment
chemical_list: D000995:Antitubercular Agents