Author: Yejin Kang
Institution: Rice University
Date: June 2010
Previous debates of whether tuberculosis (TB)-HIV patients should receive treatment for both diseases simultaneously have been resolved. A clinical trial study recently published in the February 25th issue of The New England Journal of Medicine shows that mortality was significantly reduced in co-infected TB and HIV patients when they were treated for both diseases simultaneously. Medical physicians and researchers from participating institutions, including Columbia University's Mailman School of Public Health and University of KwaZulu-Natal, collaborated on a research study to find that treatment for HIV should be initiated during TB treatment therapy.
The results of this study are especially imperative because almost 2 billion people die of TB worldwide each year, and TB is the number one cause of death among HIV patients. Salim S. Abdool Karim, reports that "treatment of HIV has been deferred until completion of tuberculosis therapy because of concern about potential drug interactions, overlapping side effects, a high pill burden, and programmatic challenges." The results of the clinical trial study are especially persuasive as it shows mortality rates reducing by 56% among the 642 participating patients who were co-infected with HIV and tuberculosis.
During the open-label, randomized, controlled trial in South Africa, only patients with a CD4+ cell count of less than the normal cell count level of 500-1500 cells per cubic millimeter were enrolled. 429 patients received integrated treatment therapy regimens while 213 patients initiated anti-retroviral therapy after completing TB treatment. The significantly-improved survival rates demonstrate that timing of treatment is crucial and that physicians can improve treatment rates just with a simple change in treatment regimen.
The findings from this study, which was conducted at the Centre for the AIDS Programme of Research in South Africa, have already been implemented into policy. The World Health Organization revised their TB and HIV treatment guidelines in late 2009. Furthermore, President Zuma of South Africa mandates that aid for HIV patients be provided to all co-infected patients. This is an important step towards mobilizing the integration of TB and HIV services and to reach the World Health Organization's goal of halting the spread of HIV and TB.
Abdool Karim et al. Timing of Initiation of Antiretroviral Drugs during Tuberculosis Therapy. New England Journal of Medicine, 2010; 362 (8): 697 DOI: 10.1056/NEJMoa0905848
Columbia University's Mailman School of Public Health. "Combined Drug Therapy to Treat TB and HIV Significantly Improves Survival." ScienceDaily 25 February 2010. 3 April 2010 .