Zanoni B.C., Phungula T., Zanoni H.M., France H., Feeney M.E.
Ragon Institute of MGH, MIT and Harvard, Charlestown, United States; Harvard Medical School, Boston, MA, United States; Sinikithemba Clinic and Philani Program, McCord Hospital, Durban, South Africa; Division of Experimental Medicine, University of California, San Francisco, CA, United States
Zanoni, B.C., Ragon Institute of MGH, MIT and Harvard, Charlestown, United States, Harvard Medical School, Boston, MA, United States, Sinikithemba Clinic and Philani Program, McCord Hospital, Durban, South Africa; Phungula, T., Sinikithemba Clinic and Philani Program, McCord Hospital, Durban, South Africa; Zanoni, H.M., Sinikithemba Clinic and Philani Program, McCord Hospital, Durban, South Africa; France, H., Sinikithemba Clinic and Philani Program, McCord Hospital, Durban, South Africa; Feeney, M.E., Ragon Institute of MGH, MIT and Harvard, Charlestown, United States, Division of Experimental Medicine, University of California, San Francisco, CA, United States
Objective: To evaluate the association between treatment of HIV-tuberculosis (TB) coinfection and primary virologic failure among children initiating antiretroviral therapy in South Africa. Design: We performed a retrospective cohort study of 1029 children initiating antiretroviral therapy at two medical centers in KwaZulu Natal, South Africa, a region of very high TB incidence. Methods: Data were extracted from electronic medical records and charts and the impact of TB cotreatment on viral suppression at 6 and 12 months was assessed using logistic regression. Results: The overall rate of virologic suppression (<400 HIV RNA copies/ml) was 85% at 6 months and 87% at 12 months. Children who received concurrent treatment for TB had a significantly lower rate of virologic suppression at 6 months (79 vs. 88%; P = 0.003). Those who received nonnucleoside reverse transcriptase inhibitor-based HAART had similar rates of viral suppression regardless of whether they received concurrent TB therapy. In contrast, children who received protease inhibitor-based HAART had significantly lower viral suppression rates at both 6 and 12 months if treated concurrently for TB (P = 0.02 and 0.03). Multivariate logistic regression revealed that age at initiation, protease inhibitor therapy, and TB coinfection were each independently associated with primary virologic failure. Conclusion: Concurrent treatment for TB is associated with lower rates of viral suppression among children receiving protease inhibitor-based HAART, but not among those receiving nonnucleoside reverse transcriptase inhibitor-based HAART. Guidelines for the care of young HIV-TB coinfected infants should be continually evaluated, as protease inhibitor-based antiviral therapy may not provide optimal viral suppression in this population. © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins.
antiretrovirus agent; ethionamide; isoniazid; lamivudine; lopinavir plus ritonavir; proteinase inhibitor; pyrazinamide; rifampicin; RNA directed DNA polymerase inhibitor; stavudine; virus RNA; article; child; cohort analysis; extrapulmonary tuberculosis; female; highly active antiretroviral therapy; human; Human immunodeficiency virus infected patient; Human immunodeficiency virus infection; incidence; major clinical study; male; mixed infection; nonhuman; patient care; priority journal; recommended drug dose; retrospective study; South Africa; tuberculosis; tuberculous meningitis; virus inhibition; AIDS-Related Opportunistic Infections; Antiretroviral Therapy, Highly Active; Antitubercular Agents; Female; HIV Protease Inhibitors; HIV-1; Humans; Practice Guidelines as Topic; Retrospective Studies; Reverse Transcriptase Inhibitors; RNA, Viral; South Africa; Tuberculosis, Pulmonary; Viral Load