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Abstract
ANTIRETROVIRAL THERAPY REDUCES THE RISK OF TUBERCULOSIS IN A HIGH PREVALENCE SETTING
WILSON D, BADRI M, STUVE K, MAARTENS G, WOOD R
Objective: To assess the impact of antiretroviral regimens on the incidence of tuberculosis (TB) in HIV-infected patients in a high TB prevalence setting. Materials: Patients presenting between 1992 and 1997 to one HIV Unit in Cape Town, South Africa (background incidence of TB 680 / 100 000). Methods: 131 HIV-infected adults randomized to receive either two nucleoside reverse transcriptase inhibitors (NRTI) or two NRTIs and a non-nucleoside reverse transcriptase inhibitor (NNRTI) were compared to 562 HIV-infected antiretroviral-naïve patients who were unable to access therapy in the state sector. Age, race, CD4 count, co-trimoxazole use, history of AIDS, and WHO stage were controlled for using a Cox multivariate proportional hazard model. Results: At baseline the groups starting antiretroviral treatment were significantly more immunosuppressed (median CD4 (interquartile range [IQR]): naïve=299 (IQR 124-418), dual=207 (IQR 54-315), triple=227 (IQR 59-331); dual vs. naïve p=0.002, triple vs. naïve p=0.01, dual vs. triple p=0.48). Forty-five patients in the treatment-naïve group were diagnosed with TB (9.9 cases per 100 patient-years) compared to 3 patients taking dual therapy (3.27 cases per 100 patient-years) and 3 patients taking triple therapy (2.69 cases per 100 patient-years). After controlling for confounding variables, the adjusted risk of tuberculosis was 0.32 (95% CI 0.12-0.8; p < 0.001) for dual therapy and 0.18 (95% CI 0.07-0.52, p <0.001) for triple therapy compared with the antiretroviral-naïve patients. The adjusted risk of triple therapy compared to dual therapy was 0.32 (95% CI 0.13-0.79; p<0.05). Conclusion: In an area with one of the highest TB incidence rates in the world both dual and triple antiretroviral therapy protect HIV-infected adults from active TB, with triple therapy being significantly more effective.
The 1st. IAS Conference on HIV Pathogenesis and Treatment
Abstract no.
66
Suggested Citation
"WILSOND, et al.
ANTIRETROVIRAL THERAPY REDUCES THE RISK OF TUBERCULOSIS IN A HIGH PREVALENCE SETTING.
Oral Presentation:
The 1st. IAS Conference on HIV Pathogenesis and Treatment
:
Abstract no.
66"
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