Antiretroviral Therapy and Tuberculosis: What's the Connection and What's the Way Forward?
- [Show abstract] [Hide abstract] ABSTRACT: Immune reconstitution inflammatory syndrome occurs in a subset of HIV-infected individuals as the immune system recovers secondary to antiretroviral therapy. An exaggerated and uncontrolled inflammatory response to antigens of viable or nonviable organisms is characteristic, with clinical deterioration despite improvement in laboratory indicators. We describe a fatal case of Mycobacterium tuberculosis meningitis immune reconstitution inflammatory syndrome in an HIV-infected child and review the literature.0Comments 0Citations
- [Show abstract] [Hide abstract] ABSTRACT: Objective: To determine tuberculosis (TB) incidence and evaluate TB risk in adults after one or more years of use of the impact of combination antiretroviral therapy (cART) one-year response on TB risk. Design: Retrospective cohort study in Jos, Nigeria. Methods: We studied a cohort of HIV-infected adults treated with cART for at least one year. Based on immunologic and virologic responses to cART, patients were categorized into four groups: CD4-Tcell count ≥ 350 cells / mm3 and HIV-1 RNA level ≤ 400 copies/ml (Group 1); CD4-Tcell count ≥ 350 cells /mm3 and HIV-1 RNA level > 400 copies/ml (Group 2); CD4-Tcell counts < 350 cells/ mm3 and HIV-1 RNA level≤400 copies/ml (Group 3) and CD4T-cell counts < 350 cells/mm3 and HIV-1 RNA level >400 copies/ml (Group 4). Time to incident TB for the four groups was analyzed using the Kaplan-Meier method. Cox regression models were used to evaluate predictors of incident TB. Results: In this cohort of 5,093 HIV infected adults, of which 68.4% were female, with mean age 35.1 years (standard deviation 9.1 years), we observed 98 cases of incident TB during four years and three months of follow-up. Overall TB incidence rate was 8.7 cases / 1000 PYFU. Adjusted hazards for incident TB were 2.11 (95% CI 0.97-4.61), 2.05 (95% CI 1.10-3.79) and 3.65(95% CI 1.15-5.06) in group 2, 3 and 4 patients respectively, compared to group 1. Conclusion: Tuberculosis incidence in patients on cART is driven by poor immunologic and/ or virologic response. Optimization of HIV treatment should be prioritized to reduce the burden of TB in this high risk population.0Comments 7Citations
Data provided are for informational purposes only. Although carefully collected, accuracy cannot be guaranteed. The impact factor represents a rough estimation of the journal's impact factor and does not reflect the actual current impact factor. Publisher conditions are provided by RoMEO. Differing provisions from the publisher's actual policy or licence agreement may be applicable.