Earlier versus later start of antiretroviral therapy in HIV-infected adults with tuberculosis.

Tuberculosis remains an important cause of death among patients infected with the human immunodeficiency virus (HIV). Robust data are lacking with regard to the timing for the initiation of antiretroviral therapy (ART) in relation to the start of antituberculosis therapy

Causes and Determinants of Mortality in HIV-Infected Adults With Tuberculosis: An Analysis From the CAMELIA ANRS 1295-CIPRA KH001 Randomized Trial

International audienceBackground. Shortening the interval between antituberculosis treatment onset and initiation of antiretroviral therapy (ART) reduces mortality in severely immunocompromised human immunodeficiency virus (HIV)–infected patients with tuberculosis. A better understanding of causes and determinants of death may lead to new strategies to further enhance survival.Methods. We assessed mortality rates, causes of death, and factors of mortality in Cambodian HIV-infected adults with CD4 count ≤200 cells/µL and tuberculosis, randomized to initiate ART either 2 weeks (early ART) or 8 weeks (late ART) after tuberculosis treatment onset in the CAMELIA clinical trial.Results. Six hundred sixty-one patients enrolled contributed to 1366.1 person-years of follow-up; 149 (22.5%) died. There were 8.3 deaths per 100 person-years (95% confidence interval [CI], 6.4–10.7) in the early-ART group and 13.8 deaths per 100 person-years (95% CI, 11.2–16.9) in the late-ART group (P = .002). Tuberculosis was the primary cause of death (28%), followed by other HIV-associated conditions (19%). Factors independently associated with mortality in the first 26 weeks were the age, body mass index, hemoglobin, interrupted or ineffective tuberculosis treatment before identification of drug resistance, disseminated tuberculosis, and nontuberculous mycobacterial disease. After 50 weeks in the trial, the most frequent causes of death were non-HIV related or tuberculosis related, including drug toxicity; factors associated with mortality were late ART, loss to follow-up, and absence of cotrimoxazole prophylaxis.Conclusions. Despite ART introduction, mortality remained high, with tuberculosis as the leading cause of death. Reducing tuberculosis-related mortality remains a challenge in resource-limited settings and requires innovative strategies

Paradoxical tuberculosis-associated immune reconstitution inflammatory syndrome after early initiation of antiretroviral therapy in a randomized clinical trial

International audienc

Efavirenz plasma concentrations at sampling time.

<p>Efavirenz plasma concentrations at sampling time.</p

Efavirenz concentrations at week 22 and week 50 in patients whose efavirenz concentrations >4,000 ng/mL.

<p>Efavirenz concentrations at week 22 and week 50 in patients whose efavirenz concentrations >4,000 ng/mL.</p

Univariate and multivariate analysis of risk factors associated with efavirenz plasma concentration below 1,000/mL.

<p>Percentiles are gender-specific. IRIS: paradoxical tuberculosis-associated immune reconstitution inflammatory syndrome.</p><p>Sampling times were: 2 weeks after ART initiation, 6 weeks after ART initiation, at 22 weeks of follow-up, and at 50 weeks of follow-up. See text for details.</p

Study design.

<p>Study design.</p