Outcomes and safety of concomitant nevirapine and rifampicin treatment under programme conditions in Malawi.
METHODS
Thyolo District Hospital, rural Malawi.


OBJECTIVE
To report on 1) clinical, immunological and virological outcomes and 2) safety among human immunodeficiency virus (HIV) infected patients with tuberculosis (TB) who received concurrent nevirapine (NVP) and rifampicin (RMP) based treatment.


METHODS
Retrospective cohort study.


METHODS
Analysis of programme data, June-December 2007.


RESULTS
Of a total of 156 HIV-infected TB patients who started NVP-based antiretroviral treatment, 136 (87%) completed TB treatment successfully, 16 (10%) died and 5 (4%) were transferred out. Mean body weight and CD4 gain (adults) were respectively 4.4 kg (95%CI 3.3-5.4) and 140 cells/mm(3) (95%CI 117-162). Seventy-four per cent of patients who completed TB treatment and had a viral load performed (n = 74) had undetectable levels (<50 copies/ml), while 17 (22%) had a viral load of 50-1000 copies/ml. Hepatotoxicity was present in 2 (1.3%) patients at baseline. Two patients developed Grade 2 and one developed Grade 3 alanine transaminase enzyme elevations during TB treatment (incidence rate per 10 years of follow-up 4.2, 95%CI 1.4-13.1). There were no reported deaths linked to hepatotoxicity.


CONCLUSIONS
In a rural district in Malawi, concomitant NVP and RMP treatment is associated with good TB treatment outcomes and appears safe. Further follow-up of patients would be useful to ascertain the longer-term effects of this concurrent treatment.
Moses
M
M
Médecins sans Frontières, Thyolo District, Thyolo, Malawi.
Zachariah
R
R
Tayler-Smith
K
K
Misinde
D
D
Foncha
C
C
Manzi
M
M
Bauerfeind
A
A
Mwagomba
B
B
Kwanjana
J
J
Harries
A D
AD
D000293:Adolescent; D000328:Adult; D019380:Anti-HIV Agents / Q000009:adverse effects / Q000627:therapeutic use; D000904:Antibiotics, Antitubercular / Q000009:adverse effects / Q000627:therapeutic use; D056486:Chemical and Drug Induced Liver Injury / Q000453:epidemiology / Q000209:etiology; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D008295:Malawi; D008297:Male; D019829:Nevirapine / Q000009:adverse effects / Q000627:therapeutic use*; D012189:Retrospective Studies; D012293:Rifampin / Q000009:adverse effects / Q000627:therapeutic use*; D016896:Treatment Outcome; D014376:Tuberculosis / Q000150:complications / Q000188:drug therapy*; D019562:Viral Load / Q000187:drug effects; D055815:Young Adult
D019380:Anti-HIV Agents; D000904:Antibiotics, Antitubercular; D019829:Nevirapine; D012293:Rifampin