Program Schedule

1576
Timing of Antiretroviral Therapy in Patients with Active Tuberculosis: a Systematic Review and Meta-analysis

Session: Poster Abstract Session: HIV: Comorbidities and Coinfections
Saturday, October 11, 2014
Room: The Pennsylvania Convention Center: IDExpo Hall BC
Posters
  • MahmoodHIVTB.pdf (1.7 MB)
  • Background:  Integration of antiretroviral (ART) and tuberculosis (TB) therapy has been shown to improve patients’ outcomes, however optimal timing for initiation of ART during the treatment of active TB is unclear.

     

    Methods: Systematic review and meta-analysis of randomized controlled trials using PubMed, EMBASE, Cochrane Library, CINAHL, clinicaltrials.gov, hand search from reference lists of identified papers.

     

    Participants and intervention: Randomized controlled trials (RCTs) comparing earlier within 4 weeks with later initiation at 8-12 weeks of ART during TB therapy in patients > 13 years of age co-infected with HIV and TB.

     

    Outcome measures: Primary outcome was all-cause mortality at 48 weeks. Secondary outcomes were incidence of immune reconstitution inflammatory syndrome (IRIS), serious adverse effects (including change in ART regimen), HIV viral load and mycobacterial clearance.

     

    Results: Data from six RCTs involving 2303 adolescent and adult patients was analyzed. Earlier initiation of ART (≤4 weeks) as compared to 8-12 weeks was associated with a non-significant decrease in overall mortality at 48 weeks (relative risk 0.81; 95% confidence intervals (CI) 0.63 to 1.05; p=0.11), however there was a twofold increase in the risk of IRIS (RR 2.21; 95% CI 1.79 to 2.23; p>0.001). In those with CD4 count less than 50 cells/μl, early ART was associated with a 43% lower risk of a new AIDS-defining illness or death (RR 0.57; 95% CI 0.38-0.86; p=0.008).

    Conclusion:

    Earlier initiation of ART significantly lowers the risk of death or developing a new AIDS-defining illness in severely immunosuppressed patients with HIV and TB co-infection.

    Table 2: Outcomes table

    Outcomes

    Number of studies

    Number of participants

    Relative risk

    95% confidence interval

    P value

    Heterogeneity

    All-cause mortality at 48 weeks

    6

    2303

    0.81

    0.63 to 1.05

    0.11

    I2 = 0%

    Incidence of IRIS

    6

    2303

    2.21

    1.79 to 2.73

    <0.001

    I2 = 0%

    Incidence of serious adverse effects

    5

    2122

    1.00

    0.94 to 1.08

    0.41

    I2 = 65%

    Change in antiretroviral therapy

    4

    1486

    2.46

    1.16 to 5.22

    0.02

    I2 = 11%

    Successful TB therapy

    3

    1271

    0.04

    -0.05 to 0.13

    0.41

    I2 = 65%

    HIV RNA <400 at 48 weeks

    4

    1843

    1.00

    0.98 to 1.03

    0.82

    I2 = 0%

    All-cause mortality at 48 weeks with CD4 count < 50

    3

    356

    0.53

    0.33 to 0.84

    0.007

    I2 = 0%

     

    igure 2: Outcomesistics of included studies

     

    Maryam Mahmood, MD1, Leena Jalota2, Poulivaati Funaki3, Gary Chan4 and Anthony Donato2, (1)Internal Medicine, Reading Hospital, West Reading, PA, (2)Reading Hospital, West Reading, PA, (3)The Alfred, Melbourne, Australia, (4)Auckland City Hospital, Auckland, New Zealand

    Disclosures:

    M. Mahmood, None

    L. Jalota, None

    P. Funaki, None

    G. Chan, None

    A. Donato, None

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