Impact of tuberculosis cotreatment on viral suppression rates among HIV-positive children initiating HAART
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
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