Early initiation of ART in co-infected TB/HIV patients in Southwestern Guatemala
C.A. López Tellez1, J.M. Ikeda2, P. Campos3, N. Hearst4
1Clínica de Atención Integral Dr. Isaac Cohen Alcahé, Medicine, Quetzaltenango, Guatemala, 2Asociación de Investigación, Desarrollo y Educación Integral, Research, Quetzaltenango, Guatemala, 3AIDS Healthcare Foundation, Latin America Office, Los Angeles, United States, 4University of Califorinia at San Francisco, Family and Community Medicine/Biostatistics, San Francisco, United States
Background: Antiretroviral therapy is essential for extending survival in TB/HIV co-infected patients. Little is known about outcome in these patients in Guatemala, where they frequently present with < 100 cells CD4/µl. We studied treatment outcome in a HIV clinic integrated into the regional TB hospital.
Methods: We conducted a prospective study with newly presenting patients. They were initiated with 50-95 TB treatment (50 days with INH, EMB, PZA and RIF followed by 95 treatments INH and RIF three times a week) and then received Emtricitabine and Tenofovir and Efavirenz daily. ART was initiated at 30 days of TB treatment for patients with CD4 < 50 cells/ µl (group 1) and 40 to 60 days for CD4 >51 cells/µl (group 2).
Results: Between January 2008 and August 2009, 86 TB/HIV co-infected patients (40% women) with mean age 36 years were included. 94% completed tuberculosis treatment and 6% died before completion. Group 1: 40% had CD4 counts less than 50 cells/ µl. On average, they doubled their CD4 count within the first three months of ART, tripled their CD4 count in five months, and 79% reached 40 HIV RNA copies per mL within 8 months. Group 2: 11% had CD4 counts from 51 to 100; they doubled their CD4 count in 5 months, and 75% reached 40 HIV RNA copies per mL in 9 months. 18% had CD4 counts from 101 to 150; they doubled their CD4 count in 4 months and 77% reached 40 HIV RNA copies per mL within 9 months. 14% had CD4 counts from 151-250; they doubled their CD4 counts in 7 months and 70% reached 40 HIV RNA copies per mL within 9 months. 10% abandoned the study.
Conclusions: These are encouraging results with early initiation of ART in co-infected patients, many of whom were severely immunosuppressed at presentation.
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