title: Outcomes in HIV-infected patients on antiretroviral therapy with tuberculosis.
abstract: HIV-infected patients with active tuberculosis (TB) having CD4 counts < 100/mm3 and who were antiretroviral therapy (ART) naïve were reviewed retrospectively to determine the outcomes of their tuberculosis infection. All patients received ART at or after receiving anti-TB treatment. Clinical manifestations, treatment regimens and outcomes were analyzed. Of 101 patients, 62 (61.4%) completed TB treatment. Of these, 53.2% were treated with a 6-month standard TB regimen, while the rest were treated with prolonged TB regimens. The median interval between anti-TB treatment and ART was 68 days (range: 0-381). Among the clinically cured patients 66.1% received rifampin concomitantly with nevirapine, and 32.3% received rifampin concomitantly with efavirenz. The treatment success rate was 75.6%, with a mortality rate of 6.1%. The risk factors for death were resistant TB (p = 0.03) and poor compliance (p < 0.05). Seven point nine percent had multi-drug resistant TB. Possible or probable immune reconstitution inflammatory syndrome (IRIS) was seen in 15 cases (14.9%). No life-threatening IRIS was reported, and it did not affect disease outcome (p = 0.5). A shorter time between anti-TB treatment and ART onset was associated with the occurrence of IRIS (31 days vs 90 days; p < 0.05). Regarding adverse drug effects, 44.6% had side effects due either to anti-TB drugs or ART. Sixty-six point one percent of them occurred within the first 2 months of TB treatment, and 43 (76.8%) had to stop or change either anti-TB treatment or ART. The mortality rate with TB and HIV on ART was low and the occurrence of IRIS did not carry any additional mortality.
authors.affiliation: Bamrasnaradura Institute, Ministry of Public Health, Nonthaburi, Thailand.
authors.forename: Somsit
authors.initials: S
authors.lastname: Tansuphasawadikul
authors.forename: Wakana
authors.initials: W
authors.lastname: Saito
authors.forename: Jerome
authors.initials: J
authors.lastname: Kim
authors.forename: Benjaluck
authors.initials: B
authors.lastname: Phonrat
authors.forename: Jittima
authors.initials: J
authors.lastname: Dhitavat
authors.forename: Supat
authors.initials: S
authors.lastname: Chamnachanan
authors.forename: Punnee
authors.initials: P
authors.lastname: Pitisuttithum
mesh_terms: D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000401:mortality / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013785:Thailand / Q000453:epidemiology; D016896:Treatment Outcome; D014376:Tuberculosis / Q000188:drug therapy
chemical_list: D044966:Anti-Retroviral Agents