The Impact of HAART Initiation Timing on HIV-TB Co-infected Patients, a Retrospective Cohort Study

Overview

Journal BMC Infect Dis

Publisher Biomed Central

Specialty Infectious Diseases

Date 2014 Jun 6

PMID 24897928

Citations 9

Authors

Chin-Hui Yang

Kuan-Jung Chen

Jih-Jin Tsai

Yu-Hui Lin

Shu-Hsing Cheng

Kwei-Feng Wang

Hung-Yi Chiou

Affiliations

Soon will be listed here.

Abstract

Background: Optimal timing for initiating highly active antiretroviral therapy (HAART) in HIV-TB coinfected patients is challenging for clinicians. We aim to evaluate the impact of different timing of HAART initiation on TB outcome of HIV-infected adults in Taiwan.

Methods: A population-based retrospective cohort study was conducted through linking the HIV and TB registries of Taiwan Centers for Disease Control (CDC) during 1997 to 2006. Clinical data of HIV-TB co-infected patients, including the presence of immune reconstitution inflammatory syndrome (IRIS), was collected through medical records review. The outcome of interest was all-cause mortality within 1 year following TB diagnosis. The Cox proportional hazard model was used to explore the probability of death and IRIS after TB diagnosis by adjusting for confounding factors and factors of interest. The probability of survival and TB IRIS were calculated by the Kaplan-Meier method and compared between different HAART initiation timing groups by the log-rank test.

Results: There were 229 HIV-TB co-infected patients included for analysis and 60 cases (26.2%) died within one year. Besides decreasing age and increasing CD4 lymphocyte count, having started HAART during TB treatment was significantly associated with better survival (adjusted Hazard Ratio was 0.11, 95% CI 0.06-0.21). As to the timing of HAART initiation, there was only non-significant benefit on survival among cases initiating HAART within 15 days, at 16-30 days and at 31-60 days of TB treatment than initiating after 60 days. Cases with HAART initiated after 30 days had lower risk in developing IRIS than cases with HAART initiated earlier. Cases with IRIS had significantly higher rate of re-hospitalization (49% vs. 4%, p < 0.001) and prolonged hospitalization (28 days vs. 18.5 days, p < 0.01).

Conclusion: The present study found that starting HAART during TB treatment is associated with better one-year survival, although earlier initiation within 60 days of TB treatment did not show statistical differences in survival than later initiation. Initiation of HAART within 30 days appeared to increase the risk of IRIS. Deferring HAART to 31-60 days of TB treatment might be optimal after considering the risks and benefits.

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References

Sun H, Chen Y, Chen I, Gau C, Chang S, Luh K . A prospective study of hepatitis during antituberculous treatment in Taiwanese patients and a review of the literature. J Formos Med Assoc. 2009; 108(2):102-11. DOI: 10.1016/s0929-6646(09)60040-1. View

Mugusi F, Mehta S, Villamor E, Urassa W, Saathoff E, Bosch R . Factors associated with mortality in HIV-infected and uninfected patients with pulmonary tuberculosis. BMC Public Health. 2009; 9:409. PMC: 2779816. DOI: 10.1186/1471-2458-9-409. View

Kendon M, Knight S, Ross A, Giddy J . Timing of antiretroviral therapy initiation in adults with HIV-associated tuberculosis: outcomes of therapy in an urban hospital in KwaZulu-Natal. S Afr Med J. 2013; 102(12):931-5. DOI: 10.7196/samj.5574. View

Castelnuovo B, Manabe Y, Kiragga A, Kamya M, Easterbrook P, Kambugu A . Cause-specific mortality and the contribution of immune reconstitution inflammatory syndrome in the first 3 years after antiretroviral therapy initiation in an urban African cohort. Clin Infect Dis. 2009; 49(6):965-72. DOI: 10.1086/605500. View

Sinha S, Shekhar R, Singh G, Shah N, Ahmad H, Kumar N . Early versus delayed initiation of antiretroviral therapy for Indian HIV-Infected individuals with tuberculosis on antituberculosis treatment. BMC Infect Dis. 2012; 12:168. PMC: 3457866. DOI: 10.1186/1471-2334-12-168. View

. Mortality among patients with tuberculosis and associations with HIV status --- United States, 1993-2008. MMWR Morb Mortal Wkly Rep. 2010; 59(46):1509-13. View

Franke M, Robins J, Mugabo J, Kaigamba F, Cain L, Fleming J . Effectiveness of early antiretroviral therapy initiation to improve survival among HIV-infected adults with tuberculosis: a retrospective cohort study. PLoS Med. 2011; 8(5):e1001029. PMC: 3086874. DOI: 10.1371/journal.pmed.1001029. View

Chilton D, Edwards S, Pellegrino P, Miller R . Factors influencing delay in initiating antiretroviral therapy among HIV infected patients coinfected with tuberculosis. Thorax. 2008; 63(10):935-6. DOI: 10.1136/thx.2008.104232. View

Dheda K, Lampe F, Johnson M, Lipman M . Outcome of HIV-associated tuberculosis in the era of highly active antiretroviral therapy. J Infect Dis. 2004; 190(9):1670-6. DOI: 10.1086/424676. View

10.

Blanc F, Sok T, Laureillard D, Borand L, Rekacewicz C, Nerrienet E . Earlier versus later start of antiretroviral therapy in HIV-infected adults with tuberculosis. N Engl J Med. 2011; 365(16):1471-81. PMC: 4879711. DOI: 10.1056/NEJMoa1013911. View

11.

Akksilp S, Karnkawinpong O, Wattanaamornkiat W, Viriyakitja D, Monkongdee P, Sitti W . Antiretroviral therapy during tuberculosis treatment and marked reduction in death rate of HIV-infected patients, Thailand. Emerg Infect Dis. 2008; 13(7):1001-7. PMC: 2878231. DOI: 10.3201/eid1307.061506. View

12.

Cain K, Anekthananon T, Burapat C, Akksilp S, Mankhatitham W, Srinak C . Causes of death in HIV-infected persons who have tuberculosis, Thailand. Emerg Infect Dis. 2009; 15(2):258-64. PMC: 2657626. DOI: 10.3201/eid1502.080942. View

13.

Luetkemeyer A, Kendall M, Nyirenda M, Wu X, Ive P, Benson C . Tuberculosis immune reconstitution inflammatory syndrome in A5221 STRIDE: timing, severity, and implications for HIV-TB programs. J Acquir Immune Defic Syndr. 2013; 65(4):423-8. PMC: 3943693. DOI: 10.1097/QAI.0000000000000030. View

14.

Kung H, Sun H, Chen M, Hsieh S, Sheng W, Chen Y . Human immunodeficiency virus testing among patients with tuberculosis at a university hospital in Taiwan, 2000 to 2006. J Formos Med Assoc. 2009; 108(4):320-7. DOI: 10.1016/S0929-6646(09)60072-3. View

15.

Sun H, Ko W, Tsai J, Lee H, Liu C, Wong W . Seroprevalence of chronic hepatitis B virus infection among taiwanese human immunodeficiency virus type 1-positive persons in the era of nationwide hepatitis B vaccination. Am J Gastroenterol. 2009; 104(4):877-84. DOI: 10.1038/ajg.2008.159. View

16.

Yang C, Huang Y, Hsiao C, Yeh Y, Liou H, Hung C . Trends of mortality and causes of death among HIV-infected patients in Taiwan, 1984-2005. HIV Med. 2008; 9(7):535-43. DOI: 10.1111/j.1468-1293.2008.00600.x. View

17.

Huang Y, Chen C, Chang F . The emerging HIV epidemic among men who have sex with men in Taiwan. J Formos Med Assoc. 2013; 112(7):369-71. PMC: 7127344. DOI: 10.1016/j.jfma.2012.10.018. View

18.

Velasco M, Castilla V, Sanz J, Gaspar G, Condes E, Barros C . Effect of simultaneous use of highly active antiretroviral therapy on survival of HIV patients with tuberculosis. J Acquir Immune Defic Syndr. 2009; 50(2):148-52. DOI: 10.1097/QAI.0b013e31819367e7. View

19.

Havlir D, Kendall M, Ive P, Kumwenda J, Swindells S, Qasba S . Timing of antiretroviral therapy for HIV-1 infection and tuberculosis. N Engl J Med. 2011; 365(16):1482-91. PMC: 3327101. DOI: 10.1056/NEJMoa1013607. View

20.

Lawn S, Campbell L, Kaplan R, Little F, Morrow C, Wood R . Delays in starting antiretroviral therapy in patients with HIV-associated tuberculosis accessing non-integrated clinical services in a South African township. BMC Infect Dis. 2011; 11:258. PMC: 3203070. DOI: 10.1186/1471-2334-11-258. View