Improved survival in multi-drug resistant tuberculosis patients receiving integrated TB and ART in the SAPiT Trial
Published Date:Feb 2014
Source:Int J Tuberc Lung Dis. 18(2):147-154.
Pubmed Central ID:PMC4770013
Funding:5U26PS001350/PS/NCHHSTP CDC HHS/United States
D43 TW000231/TW/FIC NIH HHS/United States
D43TW00231/TW/FIC NIH HHS/United States
U19 AI051794/AI/NIAID NIH HHS/United States
U2G PS001350/PS/NCHHSTP CDC HHS/United States
Therapeutic effects of antiretroviral therapy (ART) in patients with multidrug resistant tuberculosis (MDR-TB) and HIV infection have not been established.
The objective of this study was to assess therapeutic outcomes of ART integration with MDR-TB treatment.
A subgroup of MDR-TB patients from the SAPiT study, a randomized controlled trial, conducted in an out-patient clinic in Durban, South Africa from 2008–2012
Clinical outcomes at 18 months were compared in patients randomized to receive ART within 12 weeks of standard first-line tuberculosis treatment initiation with those who commenced ART after completing tuberculosis treatment.
Mycobacterium tuberculosis drug susceptibility was available in 489 (76%) of 642 SAPiT patients; 23 had MDR-TB, 14 in the integrated treatment arm and 9 in the sequential treatment arm. At 18 months, the mortality rate was 11.9/100 person-years (95% confidence interval (CI): 1.4–42.8) in the combined integrated treatment arm and 56.0/100 person-years (95%CI: 18.2–130.8) in the sequential treatment arm, (Hazard Ratio adjusted for baseline CD4 count and whether MDR-TB treatment was initiated: 0.14; 95% CI: 0.02–0.94; P=0.04).
Despite the small sample size, the 86% reduction in mortality due to early initiation of ART in MDR-TB patients was statistically significant.
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