HIV patients with TB should defer powerful antiretroviral treatments until the last stages of TB therapy if possible, researchers in the United Kingdom found. "Many physicians delay HAART [highly active antiretroviral therapy] in patients presenting with TB because of pill burden, drug interactions and toxicity," explained Dr. Gillian L. Dean. Dean and colleagues found evidence suggesting that the decision to defer HAART is often the best decision for patients with stable immune cell counts. ("Treatment of Tuberculosis in HIV-Infected Persons in the Era of Highly Active Antiretroviral Therapy," AIDS, 2002;16(1):75-83)

The researchers reviewed data from almost 200 patients treated at 12 HIV clinics in London and surrounding areas. Most of these patients (85 percent) were not being treated with HAART at presentation, they noted, and all suffered from extremely low CD4 cell counts. Patients who began HAART during TB treatment achieved significant reductions in viral load, and were significantly less likely to die or progress to AIDS, study data showed. However, more than half (54 percent) of these patients also suffered from drug complications severe enough to warrant discontinuation of either HAART or TB therapy. AIDS-defining illnesses were less common in patients who maintained CD4 cell counts of at least 100 x 106 cells/L. "Although the use of HAART led to significant reductions in viral load, AIDS-defining illnesses and mortality, coinfected patients commonly experienced adverse effects leading to interruptions in TB/HIV therapy," Dean and colleagues concluded.

Back to other CDC news for April 15, 2002

Previous Updates | Search the CDC archive