title: Will adoption of the 2010 WHO ART guidelines for HIV-infected TB patients increase the demand for ART services in India?
abstract: BACKGROUND
  In 2010, WHO expanded previously-recommended indications for anti-retroviral treatment to include all HIV-infected TB patients irrespective of CD4 count. India, however, still limits ART to those TB patients with CD4 counts <350/mm(3) or with extrapulmonary TB manifestations. We sought to evaluate the additional number of patients that would be initiated on ART if India adopted the current 2010 WHO ART guidelines for HIV-infected TB patients.
  
  
  METHODS
  We evaluated all TB patients recorded in treatment registers of the Revised National TB Control Programme in June 2010 in the high-HIV prevalence state of Karnataka, and cross-matched HIV-infected TB patients with ART programme records.
  
  
  RESULTS
  Of 6182 TB patients registered, HIV status was ascertained for 5761(93%) and 710(12%) were HIV-infected. 146(21%) HIV-infected TB patients were on ART prior to TB diagnosis. Of the remaining 564, 497(88%) were assessed for ART eligibility; of these, 436(88%) were eligible for ART according to 2006 WHO ART guidelines. Altogether, 487(69%) HIV-infected TB patients received ART during TB treatment. About 80% started ART within 8 weeks of TB treatment and 95% received an efavirenz based regimen.
  
  
  CONCLUSIONS
  In Karnataka, India, about nine out of ten HIV-infected TB patients were eligible for ART according to 2006 WHO ART guidelines. The efficiency of HIV case finding, ART evaluation, and ART initiation was relatively high, with 78% of eligible HIV-infected patients actually initiated on ART, and 80% within 8 weeks of diagnosis. ART could be extended to all HIV-infected TB patients irrespective of CD4 count with relatively little additional burden on the national ART programme.
authors.affiliation: Central TB Division, Directorate General of Health Services, Ministry of Health and Family Welfare, Government of India, New Delhi, India. kumaramv@rntcp.org
authors.forename: Ajay M V
authors.initials: AM
authors.lastname: Kumar
authors.forename: Devesh
authors.initials: D
authors.lastname: Gupta
authors.forename: B B
authors.initials: BB
authors.lastname: Rewari
authors.forename: Damodar
authors.initials: D
authors.lastname: Bachani
authors.forename: Suresh
authors.initials: S
authors.lastname: Mohammed
authors.forename: Vartika
authors.initials: V
authors.lastname: Sharma
authors.forename: Kumaraswamy
authors.initials: K
authors.lastname: Lal
authors.forename: H R Raveendra
authors.initials: HR
authors.lastname: Reddy
authors.forename: Balaji
authors.initials: B
authors.lastname: Naik
authors.forename: Rita
authors.initials: R
authors.lastname: Prasad
authors.forename: Mohammed
authors.initials: M
authors.lastname: Yaqoob
authors.forename: K G
authors.initials: KG
authors.lastname: Deepak
authors.forename: Suresh
authors.initials: S
authors.lastname: Shastri
authors.forename: Srinath
authors.initials: S
authors.lastname: Satyanarayana
authors.forename: Anthony David
authors.initials: AD
authors.lastname: Harries
authors.forename: Lakhbir Singh
authors.initials: LS
authors.lastname: Chauhan
authors.forename: Puneet
authors.initials: P
authors.lastname: Dewan
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D023241:Antiretroviral Therapy, Highly Active / Q000706:statistics & numerical data*; D002648:Child; D002675:Child, Preschool; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy*; D006801:Humans; D007194:India; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D012042:Registries; D013997:Time Factors; D014376:Tuberculosis / Q000150:complications*; D014944:World Health Organization; D055815:Young Adult