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Timing of antiretroviral therapy initiation in adults with HIV-associated tuberculosis: Outcomes of therapy in an urban hospital in KwaZulu-Natal

Mary-Anne Kendon, Stephen Knight, Andrew Ross, Janet Giddy

Abstract


Background. HIV-associated tuberculosis (TB) is common in South Africa. The optimal time for initiating antiretroviral therapy (ART) in co-infected patients is a clinical challenge.
Aim. We aimed to compare clinical outcomes of patients with HIV-associated TB who commenced ART at different stages of TB therapy.

Methods. A retrospective chart review was conducted of 458 patients who initiated ART at 28 days (immediate), 29 - 56 days (early) and 57 days (delayed) after commencing TB therapy, and clinical outcomes after 6 months of ART were compared.

Results. There was a higher mortality in the immediate group, although this was not significant. Renal impairment (hazard ratio (HR) 2.5; 95% confidence interval (CI) 1.3 - 4.9; p=0.004) and inpatient ART initiation (HR 3.7; 95% CI 1.6 - 8.2; p=0.001) were risk factors for HIV-associated TB mortality. A baseline haemoglobin concentration 10 g/dl (HR 0.2; 95% CI 0.1 - 0.6; p=0.003), extrapulmonary as opposed to pulmonary TB (PTB) (HR 0.3; 95% CI 0.1 - 0.7; p=0.005) and extrapulmonary plus PTB as opposed to PTB (HR 0.3, 95% CI 0.1 - 0.6; p=0.002) were significantly associated with decreased mortality.

Conclusion. The timing of initiation of ART after commencing TB therapy was not significantly associated with increased mortality or survival. Patients with more advanced disease were more likely to die. Early HIV testing and ART initiation is recommended to decrease mortality.

Authors' affiliations

Mary-Anne Kendon, Department of Family Medicine, University of KwaZulu-Natal, Durban

Stephen Knight, Department of Public Health Medicine, University of KwaZulu-Natal, Durban

Andrew Ross, Department of Family Medicine, University of KwaZulu-Natal, Durban

Janet Giddy, McCord Hospital, Durban

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Keywords

Human immunodeficiency virus, Tuberculosis, Antiretroviral therapy

Cite this article

South African Medical Journal 2012;102(12):931-935. DOI:10.7196/SAMJ.5574

Article History

Date submitted: 2012-01-06
Date published: 2012-09-28

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