title: Timing of antiretroviral therapy and TB treatment outcomes in patients with TB-HIV in Myanmar.
abstract: METHODS
  Integrated HIV Care programme, Mandalay, Myanmar.
  
  
  OBJECTIVE
  To determine time to starting antiretroviral treatment (ART) in relation to anti-tuberculosis treatment (ATT) and its association with TB treatment outcomes in patients co-infected with tuberculosis (TB) and the human immunodeficiency virus (HIV) enrolled from 2011 to 2014.
  
  
  METHODS
  Retrospective cohort study.
  
  
  RESULTS
  Of 1708 TB-HIV patients, 1565 (92%) started ATT first and 143 (8%) started ART first. Treatment outcomes were missing for 226 patients and were thus not included. In those starting ATT first, the median time to starting ART was 8.6 weeks. ART was initiated after 8 weeks in 830 (53%) patients. Unsuccessful outcome was found in 7%, with anaemia being an independent predictor. In patients starting ART first, the median time to starting ATT was 21.6 weeks. ATT was initiated within 3 months in 56 (39%) patients. Unsuccessful outcome was found in 12%, and in 20% of those starting ATT within 3 months. Patients with CD4 count <100/mm(3) had a four times higher risk of an unsuccessful outcome.
  
  
  CONCLUSIONS
  Timing of ART in relation to ATT was not an independent risk factor for unsuccessful outcome. Extensive screening for TB with rapid and sensitive diagnostic tests in HIV-infected persons and close monitoring of anaemia and immunosuppression are recommended to further improve TB treatment outcomes among patients with TB-HIV.
authors.affiliation: International Union Against Tuberculosis and Lung Disease (The Union), Mandalay, Myanmar.
authors.forename: A M
authors.initials: AM
authors.lastname: Thi
authors.affiliation: The Union, South-East Asia Office, New Delhi, India.
authors.forename: H D
authors.initials: HD
authors.lastname: Shewade
authors.affiliation: International Union Against Tuberculosis and Lung Disease (The Union), Mandalay, Myanmar.
authors.forename: N T T
authors.initials: NT
authors.lastname: Kyaw
authors.affiliation: International Union Against Tuberculosis and Lung Disease (The Union), Mandalay, Myanmar.
authors.forename: M M
authors.initials: MM
authors.lastname: Oo
authors.affiliation: International Union Against Tuberculosis and Lung Disease (The Union), Mandalay, Myanmar.
authors.forename: T K
authors.initials: TK
authors.lastname: Aung
authors.affiliation: National Tuberculosis Programme, Ministry of Health, Nay Pyi Taw, Myanmar.
authors.forename: S T
authors.initials: ST
authors.lastname: Aung
authors.affiliation: National AIDS Programme (NAP), Ministry of Health, Nay Pyi Taw, Myanmar.
authors.forename: H N
authors.initials: HN
authors.lastname: Oo
authors.affiliation: NAP, Ministry of Health, Mandalay, Myanmar.
authors.forename: T
authors.initials: T
authors.lastname: Win
authors.affiliation: The Union, Paris, France ; London School of Hygiene & Tropical Medicine, London, UK.
authors.forename: A D
authors.initials: AD
authors.lastname: Harries
keywords: HIV-associated TB; SORT IT; adverse TB treatment outcomes; early ART initiation; operational research; treatment outcome