Timing&of&An*retroviral&Therapy&in&Pa*ents&with&Ac*ve ...
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Characteristics of the studies in the review RESULTS Impact of early ART on mortality Initiation of ART ≤4 weeks as compared to 8-12 weeks was associated with a non-significant decrease in overall mortality at 48 weeks (RR 0.81; 95% CI 0.63 to 1.05; p=0.11). In patients with CD4 count < 50 cells/μl, earlier initiation of ART was associated with a 43% lower risk of mortality or developing a new AIDS-defining illness (RR 0.57; 95% CI 0.38-0.86; p=0.008). Timing of An*retroviral Therapy in Pa*ents with Ac*ve Tuberculosis: a Systema*c Review and Metaanalysis Maryam Mahmood 1 , Leena Jalota 1 , Poulivaa6 Funaki 2 , Gary Chan 3 , Anthony Donato 1 1Reading Health System, West Reading, Pennsylvania, USA 2The Alfred, Melbourne, Victoria, Australia 3 Auckland City Hospital, Auckland, New Zealand Poster number 1576 Maryam Mahmood [email protected] (610) 6091280 Reading Health System 5 th Ave & spruce St West Reading, PA 19611 Risk of IRIS with early initiation of ART Earlier ART associated with a twofold increase in the risk of IRIS (RR 2.21; 95% CI 1.79 to 2.23; p>0.001). Median time to development of IRIS ranged from 14-44 days with no difference between the earlier and later ART groups (p=0.95). Similar incidence of overall non-IRIS serious adverse effects regardless of timing of ART initiation (RR 1.00; 95% CI 0.94 to 1.08; p=0.93). Timing of ART initiation did not affect the number of patients with viral load less than 400 copies/ml at 48 weeks (RR 1.00; 95% CI 0.98-1.03; p=0.82) or impact on successful outcomes of tuberculosis therapy (RR 0.04; 95% CI -0.05 to 0.13; p=0.41). INTRODUCTION Tuberculosis is the most common cause of mortality in people living with HIV. In HIV and TB co-infected patients, initiating ART earlier during the course of TB treatment reduces the time for which patients are severely immunodeficient and decreases mortality. We performed a systematic review and meta- analysis to estimate and compare the actual risks and benefits of early combined therapy balanced against the pooled risk of medication changes, IRIS, and death. METHODS RCTs comparing ART initiation within 4 weeks with later initiation at 8-12 weeks during TB therapy in patients > 13 years of age co- infected with HIV and TB were included. CONCLUSION Earlier initiation of ART was associated with a significant mortality benefit in those with CD4 count less than 50 cells/μl, despite a higher incidence of IRIS. No increase in non-IRIS serious adverse effects or difference in TB and HIV treatment outcomes was noted. These findings strengthen the evidence for early initiation of ART in HIV associated pulmonary TB, particularly in those with advanced immune suppression. Implementation studies to assess the specific barriers to adaptation of integrated HIV/TB care are needed for rapid initiation of ART to become routine clinical practice. Pooled estimates of mortality risk with earlier vs. later initiation of ART Pooled estimates of mortality risk with earlier vs. later initiation of ART in patients with CD4 cell count < 50 cells/ul
Transcript of Timing&of&An*retroviral&Therapy&in&Pa*ents&with&Ac*ve ...
Characteristics of the studies in the review
RESULTS Impact of early ART on mortality Initiation of ART ≤4 weeks as compared to 8-12 weeks was associated with a non-significant decrease in overall mortality at 48 weeks (RR 0.81; 95% CI 0.63 to 1.05; p=0.11).
In patients with CD4 count < 50 cells/µl, earlier initiation of ART was associated with a 43% lower risk of mortality or developing a new AIDS-defining illness (RR 0.57; 95% CI 0.38-0.86; p=0.008).
Timing of An*retroviral Therapy in Pa*ents with Ac*ve Tuberculosis: a Systema*c Review and Meta-‐analysis
Maryam Mahmood1, Leena Jalota1, Poulivaa6 Funaki2, Gary Chan3, Anthony Donato1 1-‐Reading Health System, West Reading, Pennsylvania, USA 2-‐The Alfred, Melbourne, Victoria, Australia 3-‐ Auckland City Hospital, Auckland, New Zealand
Poster number 1576
Maryam Mahmood [email protected] (610) 609-‐1280 Reading Health System 5th Ave & spruce St West Reading, PA 19611
Risk of IRIS with early initiation of ART Earlier ART associated with a twofold increase in the risk of IRIS (RR 2.21; 95% CI 1.79 to 2.23; p>0.001). Median time to development of IRIS ranged from 14-44 days with no difference between the earlier and later ART groups (p=0.95).
Similar incidence of overall non-IRIS serious adverse effects regardless of timing of ART initiation (RR 1.00; 95% CI 0.94 to 1.08; p=0.93). Timing of ART initiation did not affect the number of patients with viral load less than 400 copies/ml at 48 weeks (RR 1.00; 95% CI 0.98-1.03; p=0.82) or impact on successful outcomes of tuberculosis therapy (RR 0.04; 95% CI -0.05 to 0.13; p=0.41).
INTRODUCTION Tuberculosis is the most common cause of mortality in people living with HIV. In HIV and TB co-infected patients, initiating ART earlier during the course of TB treatment reduces the time for which patients are severely immunodeficient and decreases mortality. We performed a systematic review and meta-analysis to estimate and compare the actual risks and benefits of early combined therapy balanced against the pooled risk of medication changes, IRIS, and death.
METHODS RCTs comparing ART initiation within 4 weeks with later initiation at 8-12 weeks during TB therapy in patients > 13 years of age co-infected with HIV and TB were included.
CONCLUSION Earlier initiation of ART was associated with a significant mortality benefit in those with CD4 count less than 50 cells/µl, despite a higher incidence of IRIS. No increase in non-IRIS serious adverse effects or difference in TB and HIV treatment outcomes was noted. These findings strengthen the evidence for early initiation of ART in HIV associated pulmonary TB, particularly in those with advanced immune suppression. Implementation studies to assess the specific barriers to adaptation of integrated HIV/TB care are needed for rapid initiation of ART to become routine clinical practice.
Pooled estimates of mortality risk with earlier vs. later initiation of ART
Pooled estimates of mortality risk with earlier vs. later initiation of ART in patients with CD4 cell count < 50 cells/ul
