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J Acquir Immune Defic Syndr. 2014 Oct 1;67(2):136-44. doi: 10.1097/QAI.0000000000000284.

The effect of tuberculosis treatment on virologic and immunologic response to combination antiretroviral therapy among South African children.

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  • 1*Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC; and ‚ĆWits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of The Witwatersrand, Johannesburg, South Africa.

Abstract

BACKGROUND:

Many HIV-infected children are diagnosed with tuberculosis (TB), but the effect of TB treatment on virologic and immunologic response to combination antiretroviral therapy (cART) is not well documented.

METHODS:

Secondary analysis of a prospective cohort of cART-naive HIV-infected South African children aged 0-8 years initiating cART to assess the effect of TB treatment at the time of cART initiation on virologic suppression (HIV RNA < 50 copies/mL), virologic rebound (HIV RNA > 1000 copies/mL after suppression), and CD4 cell percent (CD4%) increase during the first 24 months of cART.

RESULTS:

Of 199 children (median age 2.1 years), 92 (46%) were receiving TB treatment at cART initiation. Children receiving and not receiving TB treatment at cART initiation had similar median baseline HIV RNA (5.4 vs. 5.6 copies/mL), median time to virologic suppression (6.2 months in each group, adjusted hazard ratio, 1.36, 95% confidence interval: 0.94 to 1.96), and rates of virologic rebound by 24 months (23% vs. 24%, adjusted hazard ratio 1.53, 95% confidence interval: 0.71 to 3.30). Children on TB treatment had significantly lower median CD4% at baseline (15.3% vs. 18.8%, P < 0.01) and during the first 12 months of cART but experienced similar median increases in CD4% at 6 months (9.9% vs. 9.6%), 12 months (14.2% vs. 11.9%), and 24 months of cART (14.5% vs. 14.2%). Exploratory analyses suggest that children receiving lopinavir/ritonavir-based cART and TB treatment may have inferior virologic and immunologic response compared with children receiving efavirenz-based cART.

CONCLUSIONS:

Receiving TB treatment at the time of cART initiation did not substantially affect virologic or immunologic response to cART in young children.

PMID:
25072611
[PubMed - indexed for MEDLINE]
PMCID:
PMC4162748
[Available on 2015-10-01]
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