TB-HIV co-infection: Giving ART and Treating TB slow HIV progression

Dr Gabriel Chamie UCSF
The message was clear: Putting TB-HIV co-infected people on the anti-retroviral treatment (ART) do slow down HIV progression to AIDS. However ART induced immune maintenance and recovery have no difference on the outcome of anti-TB treatment in studies done in different parts of Asia and Africa, presented on second day of the XVIII International AIDS Conference (IAC) in Vienna, Austria. Read more

"The hypothesis of our study was whether the induced immune maintenance and recovery in people co-infected with both: TB and HIV, due to anti-retroviral treatment (ART), will have any clinical, radiological or microbiological responses on TB therapy," said Dr Gabriel Chamie from Department of Medicine, University of California, San Francisco. The study outcome was that there is no difference in TB therapy outcome of putting TB-HIV co-infected people on ART. Dr Chamie conducted his study in Uganda.

Similar study outcomes were in Thailand: Dr Weerawat Manosuthi, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand also didn't find any significant difference in TB treatment outcome among those TB-HIV co-infected people who were put on ART or not. "Thai study provides promising long term clinical data of nevirapine 400 mg per day based ART in people living with HIV (PLHIV) who were diagnosed with active TB and were receiving rifampicin based anti-TB treatment" said Dr Weerawat.

But these studies should not be confused – the positive health outcomes of starting antiretroviral treatment (ART) in TB-HIV co-infected people are undisputed – regardless of their CD4 count – because it slows down HIV progression to AIDS.

In high burden countries, there is a need to test all TB patients for HIV (through provider initiated HIV testing) and of those HIV-positive we must provide immediate cotrimoxazole preventive therapy and ART as soon as possible. "The most recent WHO advice issued in November 2009, is to give ART to ALL HIV infected TB patients regardless of CD4 count and to give it as soon as possible after the anti-TB treatment" said Prof Anthony Harries, Senior Adviser, International Union Against Tuberculosis and Lung Disease (The Union).

Dr Anushka Naidoo from the Centre for the AIDS Programme of Research in South Africa (CAPRISA) shared her study where she looked at the ART regimens. 6% people on ART switched from the 1st line therapy out of which 1.8% did so due to toxicity or contra-indication and 4.2% did so due to virologic failure.

The interactive question-answer session further made it clear that the recommendation to give antiretroviral treatment (ART) to all people co-infected with TB and HIV has promising benefits, but doesn't affect the anti-TB treatment outcomes.

Bobby Ramakant - Citizen News Service (CNS) 
(The author is supported by the Stop TB Partnership and PANOS Global AIDS Programme, to write from the XVIII International AIDS Conference in Vienna, Austria, for PANOSCOPE) 

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