Taking antiretrovirals and anti-TB drugs together could halve deaths
Combining antiretroviral (ARV) therapy with treatment for tuberculosis (TB) could more than halve the current mortality rate among patients co-infected with HIV and TB, saving an estimated 10 000 lives a year in South Africa.
These are the findings of a clinical trial by the Centre for the AIDS Programme of Research in South Africa (CAPRISA) in Durban, which compared mortality rates in three groups of co-infected patients who began ARV treatment at different stages of their TB therapy.
One group started taking ARVs in the first two months of TB treatment; a second group started taking them soon after completing their first two months on TB drugs; and a third group of patients did not begin ARV treatment until they had completed their six- to eight-month course of TB medication.
This third arm of the trial reflects the current practice in South Africa, which is based on the theory that taking ARV and TB drugs simultaneously can result in harmful interactions and reduce the effectiveness of both types of medications.
It is a theory that has never before been clinically tested. A recommendation by the World Health Organisation (WHO) that only patients with a CD4 count (which measures the strength of the immune system) below 50 should take TB and ARV treatment together, is based on doctors' observations.
A safety monitoring committee recommended closing down the third arm of the CAPRISA trial earlier this month, after the death rate in that group was found to be 55 percent higher than in the two groups on integrated ARV and TB treatment.
The study found that even patients with CD4 counts of between 200 and 500 were more likely to die if ARV treatment was delayed until they had finished their TB therapy. The American Association for Clinical Chemistry puts the normal CD4 count in adults from 500 to 1,500 cells per cubic millimetre of blood.
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