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Despite early ART, mortality high in adults with HIV, TB
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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.