Short report

Early initiation of antiretroviral therapy results in decreased morbidity and mortality among patients with TB and HIV

Payam Tabarsi¹ , Ali S Saber-Tehrani¹ , Parvaneh Baghaei¹ , Mojgan Padyab¹ , Davood Mansouri¹ , Majid Amiri¹ , Mohammad Reza Masjedi¹ and Frederick L Altice²

¹  Mycobacteriology Research Center, National Research Institute of Tuberculosis and Lung Disease, Shahid Beheshti University of Medical Science, Tehran, Iran

²  Yale University AIDS Program, New Haven, CT, USA

author email corresponding author email

Journal of the International AIDS Society 2009, 12:14doi:10.1186/1758-2652-12-14

Published:	16 July 2009

Abstract

Introduction

The overlapping drug toxicity profiles, drug-drug interactions and complications of management of both HIV and tuberculosis (TB) in patients with advanced HIV have not been fully delineated.

Methods

We conducted a retrospective chart review of the outcomes of tuberculosis treatment among 69 HIV-infected patients with TB, who were hospitalized in Masih Daneshvari Hospital in Tehran, Iran between 2002 and 2006, and who received standard category 1 (CAT-1) regimens. Group I (N = 47) included those treated from 2002 to 2005 with highly active antiretroviral therapy (HAART) initiated after eight weeks of TB treatment for those whose CD4 count was <200 cells/mm³. Group II (N = 22) included TB patients treated from 2005 to 2006, with HAART initiated after two weeks of TB treatment if their CD4 count was <100 cells/mm³ and eight weeks after initiation of TB treatment for those whose CD4 count was between 101 and 200 cells/mm³.

Results

There were no differences between Groups I and II with regard to: adverse drug reactions [four (8.5%) versus two (9%), p = ns]; IRIS [six (12.7%) versus three (10.7%), p = ns]; and new opportunistic infections [eight (17.0%) versus two (9.1%), p = ns]. Death, however, occurred more frequently in Group I than in Group II [13 (27.7%) versus (4.5%), p = 0.03], where HAART was initiated earlier. Injection of drugs was the most common route of HIV transmission in both groups (72.3% in Group I and 77.3% in Group II).

Conclusion

This manuscript shows that in a retrospective review of HIV/TB patients hospitalized in Tehran, improved survival was associated with earlier initiation of antiretroviral therapy in HIV/TB patients with CD4 counts of below 100 cells/mm³.