Khan F. Clin Infect Dis. 2012;55:1154-1163.
Antiretroviral therapy reduced the risk for tuberculosis relapse among those with HIV and active tuberculosis, according to researchers from McGill University in Montreal.
The researchers updated a systematic review and meta-analysis that included data on the effects of rifamycins, the schedule of dosing in the intensive phase and the use of ART on TB treatment outcomes, including failure, relapse and death. They identified studies conducted in patients with HIV and active TB that were published from January 2008 to November 2011.“Infection with HIV increases the risk of poor tuberculosis treatment outcomes including death, relapse and acquired drug resistance to antituberculosis medications,” the researchers wrote. “These worse outcomes have raised concerns surrounding the use of standard tuberculosis treatment regimens in patients with HIV.”
Seven studies were added to the update. When the data from these studies were included, the researchers found that the risk for relapse was lower among patients who received 9 or more months of rifampin treatment vs. 6 months of rifampin. The odds of relapse were also higher with shorter durations of other rifamycins.
The risk for relapse and acquired drug resistance were lower among patients who were receiving ART. When restricted to those receiving ART, post hoc meta-regression showed that there was no association between rifamycin duration, dosing schedule and outcomes.
“Expanding ART coverage and starting treatment early in the intensive phase among coinfected patients will not only lower mortality but is likely to assist in tuberculosis-control efforts by reducing tuberculosis relapse,” the researchers wrote. “Rapid expansion of ART coverage for coinfected patients is urgently needed.”
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