title: Antiretroviral therapy initiation during tuberculosis treatment and HIV-RNA and CD4 T-lymphocyte responses.
abstract: METHODS
  A large human immunodeficiency virus (HIV) clinic in South Africa.
  
  
  OBJECTIVE
  To examine the effect of initiating antiretroviral therapy (ART) on CD4 and viral response at different time periods during anti-tuberculosis treatment (<14 days, 15-60 days, or ≥60  days) using prospectively collected clinical data.
  
  
  METHODS
  Cohort data analysis for 1499 patients with tuberculosis (TB) and HIV co-infection classified according to timing of ART after the initiation of anti-tuberculosis treatment.
  
  
  RESULTS
  In adjusted modified Poisson regression models,  CD4 and viral responses showed no significant differences according to timing of ART initiation (failure to increase CD4 by 6 months, <14 days vs. >60 days: RR 1.02, 95%CI 0.85-1.22; 15-60 days vs. >60 days: RR 1.00, 95%CI 0.86-1.15; failure to suppress virus by  6 months, <14 days vs. >60 days: RR 0.98, 95%CI 0.59-1.63; 15-60 days vs. >60 days: RR 0.96, 95%CI 0.66-1.41 and viral rebound at 12 months, 14 days vs. >60 days: RR 1.43, 95%CI 0.50-4.12; 15-60 days vs. >60 days: RR 1.14, 95%CI 0.39-3.34).  Similar estimates were found in analysis restricted to patients with severe immunosuppression.
  
  
  CONCLUSIONS
  Concerns over the overlapping impact of anti-tuberculosis treatment with ART on ART response should not be a reason for delaying ART in patients with HIV-associated TB.
authors.affiliation: Clinical HIV Research Unit, Department of Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa. stakuva@witshealth.co.za
authors.forename: S
authors.initials: S
authors.lastname: Takuva
authors.forename: D
authors.initials: D
authors.lastname: Westreich
authors.forename: C N
authors.initials: CN
authors.lastname: Menezes
authors.forename: L
authors.initials: L
authors.lastname: McNamara
authors.forename: I
authors.initials: I
authors.lastname: Sanne
authors.forename: L
authors.initials: L
authors.lastname: Page-Shipp
authors.forename: M
authors.initials: M
authors.lastname: Maskew
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D000995:Antitubercular Agents / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D015496:CD4-Positive T-Lymphocytes / Q000187:drug effects*; D005260:Female; D005500:Follow-Up Studies; D006678:HIV / Q000235:genetics*; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology; D006801:Humans; D008297:Male; D015995:Prevalence; D011446:Prospective Studies; D012367:RNA, Viral / Q000032:analysis*; D013019:South Africa / Q000453:epidemiology; D014376:Tuberculosis / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology
chemical_list: D019380:Anti-HIV Agents; D000995:Antitubercular Agents; D012367:RNA, Viral