Timing of Antiretroviral Therapy in Patients with Active Tuberculosis: a Systematic Review and Meta-analysis
Background: Integration of antiretroviral (ART) and tuberculosis (TB) therapy has been shown to improve patients’ outcomes, however optimal timing for initiation of ART during the treatment of active TB is unclear.
Methods: Systematic review and meta-analysis of randomized controlled trials using PubMed, EMBASE, Cochrane Library, CINAHL, clinicaltrials.gov, hand search from reference lists of identified papers.
Participants and intervention: Randomized controlled trials (RCTs) comparing earlier within 4 weeks with later initiation at 8-12 weeks of ART during TB therapy in patients > 13 years of age co-infected with HIV and TB.
Outcome measures: Primary outcome was all-cause mortality at 48 weeks. Secondary outcomes were incidence of immune reconstitution inflammatory syndrome (IRIS), serious adverse effects (including change in ART regimen), HIV viral load and mycobacterial clearance.
Results: Data from six RCTs involving 2303 adolescent and adult patients was analyzed. Earlier initiation of ART (≤4 weeks) as compared to 8-12 weeks was associated with a non-significant decrease in overall mortality at 48 weeks (relative risk 0.81; 95% confidence intervals (CI) 0.63 to 1.05; p=0.11), however there was a twofold increase in the risk of IRIS (RR 2.21; 95% CI 1.79 to 2.23; p>0.001). In those with CD4 count less than 50 cells/μl, early ART was associated with a 43% lower risk of a new AIDS-defining illness or death (RR 0.57; 95% CI 0.38-0.86; p=0.008).
Earlier initiation of ART significantly lowers the risk of death or developing a new AIDS-defining illness in severely immunosuppressed patients with HIV and TB co-infection.
Infectious Diseases Society of America Annual Meeting
Mahmood, M., & Donato, A. A. (2014). Timing of Antiretroviral Therapy in Patients with Active Tuberculosis: a Systematic Review and Meta-analysis. Infectious Diseases Society of America Annual Meeting Retrieved from https://scholarcommons.towerhealth.org/gme_int_med_resident_program_read/509