title: Safety and effectiveness of HAART in tuberculosis-HIV co-infected patients in Brazil.
abstract: BACKGROUND
  Antiretroviral therapy (ART) significantly reduces tuberculosis (TB) incidence among persons with human immunodeficiency virus (HIV), but the safety and effectiveness of concomitant treatment for both diseases remain unclear.
  
  
  OBJECTIVE
  To evaluate the impact of ART and  anti-tuberculosis treatment on survival and risk of adverse events (AE) among co-infected individuals.
  
  
  METHODS
  In a retrospective cohort study, clinical data were collected from 618 TB-HIV patients treated with rifampin, isoniazid and pyrazinamide ± ethambutol between 1 January  1995 and 31 December 2003. Patients were categorized into two groups: highly active ART (HAART) or no ART. Different HAART regimens were evaluated. Bivariate analysis, multivariate logistic regression and survival analysis using Cox proportional hazards regression were used.
  
  
  RESULTS
  One-year  mortality was lower for patients receiving HAART (adjusted hazard ratio [aHR] 0.17, 95%CI 0.09-0.31) compared to no ART. HAART increased the risk of AE (aHR 2.08, 95%CI 1.29-3.36). The odds of AE when receiving a ritonavir + saquinavir HAART regimen was eight-fold higher compared  to no ART (OR 8.31, 95%CI 3.04-22.69), while efavirenz-based HAART was not associated with a significantly increased risk of AE (OR 1.42, 95%CI 0.76-2.65).
  
  
  CONCLUSIONS
  HIV patients with TB have significantly better survival if they receive HAART during anti-tuberculosis treatment.  Efavirenz-based HAART is associated with fewer AEs than protease inhibitor-based HAART.
authors: Institute of Thoracic Diseases, Clementino Fraga Filho University Hospital, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil. dra.anapsantos@globo.com
authors: A P G
authors: AP
authors: dos Santos
authors: A G
authors: AG
authors: Pacheco
authors: A
authors: A
authors: Staviack
authors: J E
authors: JE
authors: Golub
authors: R E
authors: RE
authors: Chaisson
authors: V C
authors: VC
authors: Rolla
authors: A L
authors: AL
authors: Kritski
authors: S R L
authors: SR
authors: Passos
authors: F C
authors: FC
authors: de Queiroz Mello
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active / Q000379:methods; D000995:Antitubercular Agents / Q000627:therapeutic use*; D001938:Brazil / Q000453:epidemiology; D060085:Coinfection / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome; D014376:Tuberculosis / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology
chemical_list: D019380:Anti-HIV Agents; D000995:Antitubercular Agents