TB / HIV: Still a Deadly Partnership  MOAB1
Type:
Oral abstract session Back
Venue: Bayside Auditorium B
Time: 11:00 - 12:30, Monday, 23.07.2007
Code: MOAB1
Co-Chairs: Gerald Friedland, United States
Jose Miro, Spain
Click here to see a webcast of this session on kaisernetwork.org

    Presentations in this session:
11:00
MOAB101
Abstract		Tuberculosis-associated immune restoration disease is associated with increased PPD-specific T cell responses detected by a whole blood interferon-γ release assay
Presented by Julian H Elliott, Australia
Elliott J.H.1, Sarun S.2, Chin S.3, Chan D.3, Chel S.2, Huffam S.2, Oelrichs R.4, Hun C.2, Pouv S.2, Teng K.H.2, Teng H.2, Saphonn V.2, Kaldor J.1, Cooper D.1, French M.5, Mean C.V.2
1National Centre in HIV Epidemiology and Clinical Research, University of New South Wales, Sydney, Australia, 2National Center for HIV/AIDS, Dermatology and STDs, Ministry of Health, Phnom Penh, Cambodia, 3National Institute of Public Health, Ministry of Health, Phnom Penh, Cambodia, 4World Bank, Global HIV/AIDS Program, Washington D.C., United States, 5University of Western Australia, Perth, Australia

11:15
MOAB102
Abstract
Powerpoint (5.49 MB)		24-week efficacy and safety of nevirapine: 400 mg versus 600 mg based HAART in HIV-infected patients with active tuberculosis receiving rifampicin
Presented by Anchalee Avihingsanon, Thailand
Manosuthi W.1, Avihingsanon A.2, Kantipong P.3, Chuchotaworn C.4, Moolphate S.5, Sakornjun W.2, Yamada N.5, Yanai H.5, Phanuphak P.2, Burger D.6, Ruxrungtham K.7
1Bamrasnaradura Institute, Nonthaburi, Thailand, 2HIV-NAT, Thai Red Cross AIDS Research Centre, Bangkok, Thailand, 3Chiangrai Hosp, Chiangrai, Thailand, 4Chest Disease Institute, Nonthaburi, Thailand, 5TB/HIV research project, RIT-JATA, Chiangrai, Thailand, 6Radbound University Medical Centre, Amsterdam, Netherlands, 7Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand

11:30
MOAB103
Abstract
Powerpoint (142 KB)		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)
Presented by Ketan Patel, India
Patel K.1, Patel A.1, Naik E.2, Ranjan R.1, Patel J.3, Tash K.4, Sinnott J.5
1Infectious Diseases Clinic, Ahmedabad, India, 2University of South Florida, Tempa, Florida, United States, 3Adit Molecular Diagnostics, Ahmedabad, India, 4Harvard University, Boston, United States, 5University of South Florida, Infectious Diseases, Tempa, Florida, United States

11:45
MOAB104
Abstract
Powerpoint (2.24 MB)		Incidence of sub-therapeutic tuberculosis drug concentrations and associated treatment outcomes among predominantly HIV-infected tuberculosis patients, Botswana
Presented by Sekai Chideya, United States
Chideya S.1, Peloquin C.2, Winston C.1, Wells C.1, Tappero J.3
1Centers for Disease Control and Prevention, Division of Tuberculosis Elimination, Atlanta, Georgia, United States, 2National Jewish Medical and Research Center, Infectious Disease Pharmacokinetics Laboratory, Denver, Colorado, United States, 3Centers for Disease Control and Prevention, Global AIDS Program, Kampala, Uganda

12:00
MOAB105
Abstract
Powerpoint (165 KB)		Mortality associated with tuberculosis in HIV positive and negative patients in the HAART era, in Rio de Janeiro, Brazil
Presented by Valéria Rolla, Brazil
Schmaltz C.1, Marinho F.1, Souza S.1, Lourenço C.2, Morgado M.1, Rolla V.1, Lopes G.3
1IPEC/FIOCRUZ, Infectious Diseases, Rio de Janeiro, Brazil, 2IPEC/FIOCRUZ, Bacteriology Laboratory, Rio de Janeiro, Brazil, 3HUCFF/UFRJ, Infectious Diseases, Rio de Janeiro, Brazil


Audio files:
  1. audio file - high quality (mp3 format, 39.5 MB)
  2. audio file - low quality (mp3 format, 19.9 MB)

Rapporteur report

Track B: Clinical Research, Treatment and Care report by Sarah Pett

Elliot and colleagues explored the incidence of immune reconstitution inflammatory syndrome (IRIS) in a setting with a high background rate of tuberculosis. HIV-infected ART naïve patients were recruited prospectively at a single site in Cambodia and followed for at least 24 weeks. Two groups of patients were identified those with paradoxical TB-IRIS in the setting of existing TB who were then treated with ART and those with incident TB while on ART who subsequently developed TB-IRIS. Results: 155 patients started ART and of these 17% started ART while on TB treatment, 83% started without active TB. 22% (n=6) of those who has TB pre-ART commencement developed TB-IRIS, 1 patient in this group died; 78% did not developed TB-IRIS. 5% of the groups who started ART without active TB developed incident TB, no cases of TB-IRIS. Factors associated with TB-IRIS were WHO stage IV, and there was a trend with low baseline CD4+ T-cell count and earlier initiation of ART (<60 days) following TB treatment. There was a n early rapid increase in the QuantiFERON-TB gold In-tube assay for PPD antigens but not RD1 antigens in those who developed TB-IRIS. In addition, there was an association between the development of incident TB on ART and increased IFN-gamma production in response to the RD1 antigens pre-ART and in response to both antigens during the early ART treatment phase. Similar responses were seen with PPD skin testing. Conclusion: Whole blood QuantiFERON-TB gold In-tube assay may have a role in differentiating TB-IRIS from clinical deterioration during early ART and in the prediction and diagnosis of early incident TB on ART.  

 

It is known that rifampicin is associated with a 20-50% reduction in nevirapine (NVP) levels. NVP can be used as an alternative to efavirenz in cases of intolerance. Avihingsanon et al presented the 24 weeks safety and efficacy of 600mg NVP (with a 200mg bid two week lead in) vs. 400mg bid (with a 200mg qd lead in) during treatment of TB. 31 patients on TB drugs including rifampicin for 2-6 weeks were enrolled. The backbone NRTI used was AZT and 3TC. At two weeks, 80% of those in the NVP 400mg qd group had subtherapeutic NVP levels. In the ITT analysis, 63% vs. 56% of patients had a plasma HIV RNA <LLQ (50 cp/mL) at 24 weeks; in the on treatment groups there was no significant difference between the high vs. usual dose NVP groups with respect to viral suppression i.e. 100 vs. 83% respectively. The study was terminated early because of higher rates on NVP hypersensitivity when NVP 200mg bid was used in the lead in period and no further studies of higher dose NVP are recommended. Patel et al explored the long term response to EFV-based CART when co-administered with TB treatment. In 383 patients on 9 months of TB treatment which included rifampicin were followed for at least 12 months. Treatment failure was defined as a failure to increase CD4+ T-cells counts >30% from baseline or no clinical improvement, viral loads were not performed. Time to failure was equivalent, i.e.23 (12%) in TB group vs. 19 (10%) p=0.715.

 

Chideya and colleagues performed a prospective study exploring the PK of TB drugs in HIV infected adults with smear +ve TB on TB treatment for 7-13 days at study entry. A single fasted pre-dose PK sample was performed. Clinical evaluations were performed at 2, 6, 12 mths after TB treatment initiation.  No patients received ART. Treatment failures were those who were smear +ve at 6 mths, or without clinical improvement or death within 6 mths. Of 225 patients, 70 were HIV negative; 71 and 84 were HIV-infected with CD4+ T-cells of >200 and <200 cells/uL respectively. The HIV infected patients had lower levels of TB drugs RIF, ETH and INH. In those with CD4+ of <200 cells/uL rifampicin  levels were lower (p=0.05). Risk factors for poor treatment outcomes andwere low pyrazinamide (PZA) levels and CD4+ <200 cells/uL. Low PZA was associated with treatment failure (RR 5.7) and death during treatment (RR 4.5). Conclusion: low TB drug levels were seen in HIV-infected patients with TB, and low PZA carries a higher risk of treatment failure and death.  Rolla et al presented data from the Rio cohort of TB infected (TB culture positive) patients. 106 HIV infected patients and 101 HIV –ve were included. The majority were treated with NRTI-EFV and NRTI- SQV/r. Mortality rates were higher in the HIV +ve compared to HIV –ve patients p=<0.001, HAART-treated patients had better survival. Disseminated and MAC and lack of RIF use were associated with a higher risk of death. Risk was higher if resistant to RIF and severe ADR, but abandonment of TB therapy was not associated with increased risk of death. Lack of HAART and disseminated TB = higher mortality.


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