Safety and effectiveness of HAART in tuberculosis-HIV co-infected patients in Brazil

Abstract

Background: Antiretroviral therapy (ART) significantly reduces tuberculosis (TB) incidence among persons with human immunodeficiency virus (HIV), but the safety and effectiveness of concomitant treatment for both diseases remain unclear.

Objective: To evaluate the impact of ART and anti-tuberculosis treatment on survival and risk of adverse events (AE) among co-infected individuals.

Methods: In a retrospective cohort study, clinical data were collected from 618 TB-HIV patients treated with rifampin, isoniazid and pyrazinamide ± ethambutol between 1 January 1995 and 31 December 2003. Patients were categorized into two groups: highly active ART (HAART) or no ART. Different HAART regimens were evaluated. Bivariate analysis, multivariate logistic regression and survival analysis using Cox proportional hazards regression were used.

Results: One-year mortality was lower for patients receiving HAART (adjusted hazard ratio [aHR] 0.17, 95%CI 0.09-0.31) compared to no ART. HAART increased the risk of AE (aHR 2.08, 95%CI 1.29-3.36). The odds of AE when receiving a ritonavir + saquinavir HAART regimen was eight-fold higher compared to no ART (OR 8.31, 95%CI 3.04-22.69), while efavirenz-based HAART was not associated with a significantly increased risk of AE (OR 1.42, 95%CI 0.76-2.65).

Conclusion: HIV patients with TB have significantly better survival if they receive HAART during anti-tuberculosis treatment. Efavirenz-based HAART is associated with fewer AEs than protease inhibitor-based HAART.

Figure 1

Diagram of study population. TB = tuberculosis; HIV = human immunodeficiency virus; NTM = non-tuberculous mycobacteria; MDR-TB = multidrug-resistant TB; R = rifampin; H = isoniazid; Z = pyrazinamide.

Figure 2

Kaplan-Meier survival curves comparing deaths among patients with TB-HIV co-infection by ART regimen. ART = antiretroviral therapy; HAART = highly active ART; TB = tuberculosis; HIV = human immunodeficiency virus.