Abstract

TB co-infection treated at onset of therapy does not affect long-term risk of treatment failure among HIV-1 patients initiating efavirenz (EFV)-based combination antiretroviral treatment (cART)

Objectives: We previously reported that HIV/TB co-infection can be treated by co-administration of rifampicin and an EFV-based cART regimen without compromising antiviral efficacy. However, it is possible that rifampicin coadministration at the onset of cART has negative implications for long-term prognosis. Through an extended followup from previous cohort we examined whether a prior TB treatment predicts an increased risk of treatment failure.
Study Design: A prospective, longitudinal cohort study of HIV-1-infected, naïve patients initiating EFV (600mg)-based cART. Patients with minimum of 12 months follow-up were included in analysis. Patients with tuberculosis received 9 months of rifampicin-containing anti-TB treatment with EFV-based cART, while those without tuberculosis received EFV-based cART alone, after 9 months all patients received EFV-based cART alone. Clinical evaluation occurred monthly, and CD4 cell counts were performed every 3 months.
Results: At the onset of therapy, 195 patients were TB coinfected, while 188 were not. Baseline median CD4 count (90 versus 126) and weight were lower among TB coinfected patients (p= 0.002 & p< 0.0001, respectively). Comparable improvement in CD4 count was observed in patients with and without TB co-infection at each time point up to 3 years of follow-up.

[Figure 1: Median rise in CD4 in TB and non TB Grou]
The rate of irregular follow-up and those lost/died were similar in the two groups (p= 0.33). Immunologic failure was observed in 12.3% and 11.2% patients with and without TB (p= 0.72) respectively.
Conclusion: After up to three years of follow-up, a history of TB co-infection treated with rifampicin did not predict an increased risk of treatment failure among HIV-infected patients on EFV-based cART.