HIV & TB:IN SERIOUS HIV PATIENT HAART SHOULD BE STARTED SOON AFTER TB THERAPY BUT PERSONS HAVING MORE CD4 HAART CAN BE ADDED AFTER 2-3MONTHS TO PREVENT " IRIS "
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HIV & TB:IN SERIOUS HIV PATIENT HAART SHOULD BE STARTED SOON AFTER TB THERAPY BUT PERSONS HAVING MORE CD4 HAART CAN BE ADDED AFTER 2-3MONTHS TO PREVENT " IRIS "
PROF.DRRAM ,HIV/AIDS,SEX Diseases,Deaddiction & Hepatitis Expert
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In sub-Saharan Africa,Asian countries and poor Hispanic and black americans,tuberculosis is the disease that most often brings people with HIV into the clinic for treatment. Infection with both diseases is so common that in South Africa, for instance, 70% of tuberculosis patients are HIV positive. How best to treat these doubly infected patients-- who number around 700,000 globally-- is the subject of a new study, published in The New England Journal of Medicine, by scientists at Columbia University's Mailman School of Public Health and CAPRISA (Centre for the AIDS Programme of Research in South African .
The SAPIT (Starting Antiretroviral Therapy at Three Points in Tuberculosis) study is the first randomized, controlled trial to examine the timing of the dual therapy. Conducted in South Africa, the study involved 642 patients, all with confirmed tuberculosis (TB) and HIV infection. The current paper look at results for 429 patients, half of whom were randomly assigned to begin treatment for HIV within the first four weeks of starting drug therapy for tuberculosis and half of whom were assigned to later treatment -- about 3 months after beginning the TB drugs. (A third arm of the study, with 213 patients treated for HIV only after their TB treatment was complete, was discontinued when it became clear that waiting to start ART till after completing TB treatment brought poorer results.)
All patients in the study received a standard tuberculosis treatment regimen that began with an "intensive" phase of four drugs: rifampin, isoniazid, ethambutol, and pyrazinamide, followed by a four-month "continuing" phase of treatment with just two drugs -- isoniazid and rifampmicin. Patients in the early-ART group (214 individuals) began retroviral drug treatment during the intensive phase, at a median of 21 days after beginning TB therapy. The later-ART group (215 patients) began retroviral therapy during the continuing phrase, at a median of 97 days.
While starting ART earlier was of great benefit for patient with advanced HIV disease, waiting until after three months of TB treatment to start ART may be an appropriate option for those with less advanced HIV disease, as indicated by higher T-cell counts.
"In fact, we found that the later initiation of ART actually cut the risk of an adverse reaction called IRIS (immune reconstitution inflammatory syndrome) by about half and lowered significantly the need to switch antiretroviral drugs because of side effects," noted Dr. Karim. However, waiting longer to start ART until after TB treatment is completed would be a mistake, he observes, especially in light of earlier findings that such delay was associated with 56% higher mortality.
profdrram@gmail.com,+917838059592,+919832025033,DELHI,INDIA
HIV/ AIDS,CANCER MODERN MEDICINES AVAILABLE AT CHEAP RATE.
FOLLOW ON FACE BOOK:www.facebook.com/ramkumar
FOLLOW ON TWITTER:www.twitter.com/profdrram
In sub-Saharan Africa,Asian countries and poor Hispanic and black americans,tuberculosis is the disease that most often brings people with HIV into the clinic for treatment. Infection with both diseases is so common that in South Africa, for instance, 70% of tuberculosis patients are HIV positive. How best to treat these doubly infected patients-- who number around 700,000 globally-- is the subject of a new study, published in The New England Journal of Medicine, by scientists at Columbia University's Mailman School of Public Health and CAPRISA (Centre for the AIDS Programme of Research in South African .
The SAPIT (Starting Antiretroviral Therapy at Three Points in Tuberculosis) study is the first randomized, controlled trial to examine the timing of the dual therapy. Conducted in South Africa, the study involved 642 patients, all with confirmed tuberculosis (TB) and HIV infection. The current paper look at results for 429 patients, half of whom were randomly assigned to begin treatment for HIV within the first four weeks of starting drug therapy for tuberculosis and half of whom were assigned to later treatment -- about 3 months after beginning the TB drugs. (A third arm of the study, with 213 patients treated for HIV only after their TB treatment was complete, was discontinued when it became clear that waiting to start ART till after completing TB treatment brought poorer results.)
All patients in the study received a standard tuberculosis treatment regimen that began with an "intensive" phase of four drugs: rifampin, isoniazid, ethambutol, and pyrazinamide, followed by a four-month "continuing" phase of treatment with just two drugs -- isoniazid and rifampmicin. Patients in the early-ART group (214 individuals) began retroviral drug treatment during the intensive phase, at a median of 21 days after beginning TB therapy. The later-ART group (215 patients) began retroviral therapy during the continuing phrase, at a median of 97 days.
While starting ART earlier was of great benefit for patient with advanced HIV disease, waiting until after three months of TB treatment to start ART may be an appropriate option for those with less advanced HIV disease, as indicated by higher T-cell counts.
"In fact, we found that the later initiation of ART actually cut the risk of an adverse reaction called IRIS (immune reconstitution inflammatory syndrome) by about half and lowered significantly the need to switch antiretroviral drugs because of side effects," noted Dr. Karim. However, waiting longer to start ART until after TB treatment is completed would be a mistake, he observes, especially in light of earlier findings that such delay was associated with 56% higher mortality.
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