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Session 154 Poster Abstracts
Tuberculosis and HIV
Wednesday, 1:30 - 3:30 pm
Hall B


890    
Optimal Timing of Administration of ART in AIDS Patients with Tuberculosis
Santiago Moreno*1, J Oliva1, E Navas1, P Miralles1, J González2, R Rubio3, F Pulido3, E Valencia4, A Arranz5, and J Sanz5
1Hosp Ramon y Cajal, Madrid, Spain; 2Hosp La Paz, Madrid, Spain; 3Hosp 12 de Octubre, Madrid, Spain; 4Hosp Carlos III, Madrid, Spain; and 5Hosp Principe de Asturias, Madrid, Spain

Background:  The best moment to initiate art in HIV-infected patients who are treated for tuberculosis (TB) has not been determined.

Methods:  The clinical charts of all HIV-infected patients with culture-confirmed TB diagnosed between January 1996 and January 2000 in 4 public hospitals in Madrid were reviewed. Information on clinical, immunologic, and virologic evolution of HIV infection, as well as the outcome of TB, and the tolerance and compliance to the treatment was gathered. We evaluated the risk of clinical progression of HIV infection or death according to the time of initiation of ART (during or after treatment for TB). The risk of progression was estimated by survival analysis (Kaplan-Meier) and compared by the log-rank test. Multivariate analysis was performed using a Cox proportional hazard model.

Results:  The charts of 344 evaluable patients were reviewed (mean age 35 years; male 83%). Risk factor for HIV infection was drug abuse in 79% (26% were active drug users at the moment of TB diagnosis). Mean CD4 cell count was 97 cells/mm3 and in 20% of the cases the patients had previous AIDS. The treatment of TB was completed in 64% of the cases, and included rifampin in 94%. Significant anti-TB drug toxicity occurred in 25% of the patients. A total of 74% of the patients received ART, and it was administered concomitantly with the treatment of TB in 88%. During follow-up, development of B- or C-defining illnesses or death occurred in 37.5% of the cases. By multivariate analysis, clinical progression was associated with a low CD4 count at the time of TB diagnosis, a previous diagnosis of AIDS, and the initiation of antiretroviral therapy after completion of TB treatment. When stratified by CD4 count, patients with > 200 CD4 cells/mm3 had a similar risk of progression regardless of the administration of ART during or after TB treatment. The risk of clinical progression was not different in patients who received ART during or after the first 2 months of TB therapy, irrespective of CD4 count.

Conclusions:  In our HIV-infected cohort with TB, the degree of immunosuppression, but not the delay in initiating ART was associated with a worse outcome. Even in patients with < 200 cells/mm3 ART can be started after completing the first 2 months of TB treatment.

 

 

Keywords: Tuberculosis; Rifampin; Mycobacterium tuberculosis