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Despite early ART, mortality high in adults with HIV, TB
Mortality was high among adults with HIV and tuberculosis despite early introduction of antiretroviral therapy, according to results from the CAMELIA trial.
“Tuberculosis played a major role in mortality in this patient series, especially during the first 6 months following diagnosis,” the researchers wrote in Clinical Infectious Diseases. “Thus, optimized case management should include early-ART initiation and opportunistic infection prophylaxis, appropriate management of [TB-associated immune reconstitution inflammatory syndrome] and toxicities, as well as support of adherence to avoid treatment interruption, but also possibly intensification of tuberculosis initial treatment.”
The CAMELIA trial was a randomized, open-label trial in which 661 patients with TB and CD4 counts ≤200 cells/mcL were randomly assigned to initiate ART 2 weeks after starting TB treatment or 8 weeks after starting TB treatment. Besides standard TB treatment, the patients received cotrimoxazole prophylaxis and fluconazole when CD4 counts were <100 cells/mcL.
In 1,366.1 person-years of follow-up, 149 people died. In the early-ART group, the mortality rate was 8.3 deaths per 100 person-years, and in the late-ART group, the rate was 13.8 deaths per 100 person-years (P=.002). TB was the cause of death for 28.2%, followed by HIV-associated conditions (18.8%).
Independent risk factors for early death (before week 26) included age at least 40 years, BMI ≤ 16, hemoglobin <70 g/L, disseminated TB or non-TB mycobacterial disease at enrollment, and inadequate TB therapy. n
Marcy O. Clin Infect Dis. 2014;doi:10.1093/cid/ciu283.
Disclosure: The researchers report no relevant financial disclosures.