High rates of virological suppression in a cohort of human immunodeficiency virus-positive adults receiving antiretroviral therapy in ethiopian health centers irrespective of concomitant tuberculosis.
BACKGROUND
Antiretroviral therapy (ART) initiation during treatment for tuberculosis (TB) improves survival in human immunodeficiency virus (HIV)/TB-coinfected patients. We compared virological suppression (VS) rates, mortality, and retention in care in HIV-positive adults receiving care in 5 Ethiopian health centers with regard to TB coinfection.


METHODS
Human immunodeficiency virus-positive ART-naive adults eligible for ART initiation were prospectively recruited. At inclusion, all patients underwent microbiological investigations for TB (sputum smear, liquid culture, and polymerase chain reaction). Virological suppression rates after 6 months of ART (VS; viral load <40 and <400 copies/mL) with regard to TB status was the primary outcome. The impact of HIV/TB coinfection on VS rates was determined by multivariate regression analysis. Mortality and retention in care were analyzed by proportional hazard models.


RESULTS
Among 812 participants (TB, 158; non-TB, 654), 678 started ART during the follow-up period (TB, 135; non-TB, 543). No difference in retention in care between TB and non-TB patients was observed during follow-up; 25 (3.7%) patients died, and 17 (2.5%) were lost to follow-up (P = .30 and P = .83, respectively). Overall rates of VS at 6 months were 72.1% (<40 copies/mL) and 88.7% (<400 copies/mL), with similar results for subjects with and without TB coinfection (<40 copies/mL: 65 of 92 [70.7%] vs 304 of 420 [72.4%], P = .74; <400 copies/mL: 77 of 92 [83.7%] vs 377 of 420 [89.8%], P = .10, respectively).


CONCLUSIONS
High rates of VS can be achieved in adults receiving ART at health centers, with no significant difference with regard to TB coinfection. These findings demonstrate the feasibility of combined ART and anti-TB treatment in primary healthcare in low-income countries.


BACKGROUND
NCT01433796.
Infectious Diseases Research Unit, Department of Clinical Sciences, Faculty of Medicine.
Anton
A
Reepalu
Infectious Diseases Research Unit, Department of Clinical Sciences, Faculty of Medicine ; Ministry of Health, Addis Ababa , Ethiopia.
Taye Tolera
TT
Balcha
Infectious Diseases Research Unit, Department of Clinical Sciences, Faculty of Medicine.
Sten
S
Skogmar
Oromia Regional Health Bureau , Addis Ababa , Ethiopia.
Zelalem Habtamu
ZH
Jemal
Clinical Microbiology , Regional and University Laboratories , Region Skåne , Sweden.
Erik
E
Sturegård
Department of Laboratory Medicine Malmö , Lund University , Malmö , Sweden.
Patrik
P
Medstrand
Infectious Diseases Research Unit, Department of Clinical Sciences, Faculty of Medicine.
Per
P
Björkman
ART; Ethiopia; health centers; outcome; tuberculosis