Improved survival in multidrug-resistant tuberculosis patients receiving integrated tuberculosis and antiretroviral treatment in the SAPiT trial.
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Date
2014
Journal Title
Journal ISSN
Volume Title
Publisher
International Journal of Tuberculosis and Lung Disease.
Abstract
BACKGROUND: The therapeutic effects of antiretroviral treatment (ART) in patients with multidrug-resistant tuberculosis (MDR-TB) and human immunodeficiency virus (HIV) infection have not been established.
Objective : To assess therapeutic outcomes of integrating ART with treatment for MDR-TB.
Design: A subgroup of MDR-TB patients from a randomised controlled trial, the SAPiT (Starting Antiretroviral Therapy at Three Points in Tuberculosis) study, conducted in an out-patient clinic in Durban, South Africa, from 2008 to 2012.
Methods : Clinical outcomes at 18 months were compared in patients randomised to receive ART within 12 weeks of initiating standard first-line anti-tuberculosis treatment with those who commenced ART after completing anti-tuberculosis treatment.
Results : Mycobacterium tuberculosis drug susceptibility results were available in 489 (76%) of 642 SAPiT patients: 23 had MDR-TB, 14 in the integrated treatment arm and 9 in the sequential treatment arm. At 18 months, the mortality rate was 11.9/100 person-years (py; 95%CI 1.4–42.8) in the combined integrated treatment arm and 56.0/100 py (95%CI 18.2–130.8) in the sequential treatment arm (hazard ratio adjusted for baseline CD4 count and whether MDR-TB treatment was initiated: 0.14;
95%CI 0.02–0.94, P " 0.04).
Conclusion: Despite the small sample size, the 86% reduction in mortality due to early initiation of ART in MDR-TB patients was statistically significant.
Description
Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South Africa.
Departments of Internal Medicine and Epidemiology, Yale University School of Medicine, New Haven, Connecticut, USA.
Keywords
HIV treatment., MDR-TB.
Citation
Padayatchi, N.; Abdool Karim, S.S.; Naidoo, K.; Grobler, A.; Friedland, G. 2014. Improved survival in multidrug-resistant tuberculosis patients receiving integrated tuberculosis and antiretroviral treatment in the SAPiT trial. International Journal of Tuberculosis and Lung Disease 18(2), 147-154.