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Effect of TB on HIV Viral Load Response in Patients Accessing ART at Themba Lethu Clinic, South Africa
Sharlaa Faesen*1, B Malope-Kgokong1, D Westreich2, P MacPhail1, and I Sanne1
1Univ of the Witwatersrand, Johannesburg, South Africa and 2Univ of North Carolina at Chapel Hill, US
Background: Co-infection
with tuberculosis (TB) in HIV-infected patients is commonly seen in South
African patients and complicates the administration of and response to ART.
Methods: By September 2007, Thembalethu Clinic
in South Africa had enrolled 8760 HIV-infected patients, 5783(66%) females and 2977(34%)
males for ART, of whom 2013 (23%) had a history of TB before, at initiation, or
during ART. Retrospective analysis of these co-infected patients on the viral
load and CD4 count response to ART is indicated.
Results: About 41% (832), 263(13%), and
625(31%) of those with history of TB, were diagnosed more than 6, 3 to 6, and 0
to 3 months before ART initiation, 185(9%) where diagnosed at the time of ART
initiation , 108 (5%) >3 months later. Although the overall female to male
ratio at the clinic is 1.9:1, co-infection with TB was more common in males than
females decreasing the ratio to 1.5:1. The mean age was similar between the TB
and non-TB groups but as with the non-infected group (p >0.6), age was
significantly higher in TB co-infected males than females (37.7 [7.9] vs 34.2
[7.9]; p <0.0001). Baseline mean log viral loads were higher in between
TB co-infected patients than those without TB (3.9 [1.8] vs 3.6 [1.8]; p
>0.3; n = 258). However, after 3 months of ART, the mean viral loads
were similar between the 2 groups (p >0.05). The mean log viral load
in the 258 subjects with baseline viral loads decreased significantly at 3-, 6-,
and 10-month intervals (p <0.0001) and was not significantly different
during these time intervals to those of non-infected subjects (p <0.05).
Patient with TB had higher recorded death rate than those without TB (6% vs 3%);
(χ2 = 4.8, p <0.02) and death occurred earlier during
treatment.
Conclusions: HIV patients
co-infected with TB had similar viral load response to those without any
history of TB regardless of time of diagnosis during ART initiation. Delay of
ART in these co-infected patients is not necessary, and may be a contributing
factor to the higher death rate in this group.
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