Improving survival with tuberculosis & HIV treatment integration: A mini-review
Tuberculosis (TB) is a leading cause of morbidity and mortality among HIV-infected patients while HIV remains a key risk factor for the development of active TB infection. Treatment integration is a key in reducing mortality in patients with HIV-TB co-infection. However, this opportunity to improve...
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| Veröffentlicht in: | Indian journal of medical research (New Delhi, India : 1994) India : 1994), 2019-08, Vol.150 (2), p.131-138 |
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| creator | Naidoo, Kogieleum Rampersad, Sanisha Karim, Salim |
| description | Tuberculosis (TB) is a leading cause of morbidity and mortality among HIV-infected patients while HIV remains a key risk factor for the development of active TB infection. Treatment integration is a key in reducing mortality in patients with HIV-TB co-infection. However, this opportunity to improve outcomes of both infections is often missed or poorly implemented. Challenges in TB-HIV treatment integration range from complexities involving clinical management of co-infected patients to obstacles in health service-organization and prioritization. This is evident in high prevalence settings such as in sub-Saharan Africa where TB-HIV co-infection rates reach up to 80 per cent. This review discusses published literature on clinical trials and cohort studies of strategies for TB-HIV treatment integration aimed at reducing co-infection mortality. Studies published since 2009, when several treatment guidelines recommended treatment integration, were included. A total of 43 articles were identified, of which a total of 23 observational studies and nine clinical trials were informative on TB-HIV treatment integration. The data show that the survival benefit of AIDS therapy in patients infected with TB can be maximized among patients with advanced immunosuppression by starting antiretroviral therapy (ART) soon after TB treatment initiation, i.e. in patients with CD4+ cell counts |
| doi_str_mv | 10.4103/ijmr.IJMR_660_19 |
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Treatment integration is a key in reducing mortality in patients with HIV-TB co-infection. However, this opportunity to improve outcomes of both infections is often missed or poorly implemented. Challenges in TB-HIV treatment integration range from complexities involving clinical management of co-infected patients to obstacles in health service-organization and prioritization. This is evident in high prevalence settings such as in sub-Saharan Africa where TB-HIV co-infection rates reach up to 80 per cent. This review discusses published literature on clinical trials and cohort studies of strategies for TB-HIV treatment integration aimed at reducing co-infection mortality. Studies published since 2009, when several treatment guidelines recommended treatment integration, were included. A total of 43 articles were identified, of which a total of 23 observational studies and nine clinical trials were informative on TB-HIV treatment integration. The data show that the survival benefit of AIDS therapy in patients infected with TB can be maximized among patients with advanced immunosuppression by starting antiretroviral therapy (ART) soon after TB treatment initiation, i.e. in patients with CD4+ cell counts <50 cells/μl. However, patients with greater CD4+ cell counts should defer initiation of ART to no less than eight weeks after initiation of TB treatment to reduce the occurrence and extent of immune reconstitution disease and subsequent hospitalization. Addressing operational challenges in integrating TB-HIV care can significantly improve patient outcomes, generate substantial public health impact by decreasing morbidity and death in settings with a high burden of HIV and TB.</description><identifier>ISSN: 0971-5916</identifier><identifier>DOI: 10.4103/ijmr.IJMR_660_19</identifier><identifier>PMID: 31670268</identifier><language>eng</language><publisher>India: Wolters Kluwer India Pvt. 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Treatment integration is a key in reducing mortality in patients with HIV-TB co-infection. However, this opportunity to improve outcomes of both infections is often missed or poorly implemented. Challenges in TB-HIV treatment integration range from complexities involving clinical management of co-infected patients to obstacles in health service-organization and prioritization. This is evident in high prevalence settings such as in sub-Saharan Africa where TB-HIV co-infection rates reach up to 80 per cent. This review discusses published literature on clinical trials and cohort studies of strategies for TB-HIV treatment integration aimed at reducing co-infection mortality. Studies published since 2009, when several treatment guidelines recommended treatment integration, were included. A total of 43 articles were identified, of which a total of 23 observational studies and nine clinical trials were informative on TB-HIV treatment integration. The data show that the survival benefit of AIDS therapy in patients infected with TB can be maximized among patients with advanced immunosuppression by starting antiretroviral therapy (ART) soon after TB treatment initiation, i.e. in patients with CD4+ cell counts <50 cells/μl. However, patients with greater CD4+ cell counts should defer initiation of ART to no less than eight weeks after initiation of TB treatment to reduce the occurrence and extent of immune reconstitution disease and subsequent hospitalization. Addressing operational challenges in integrating TB-HIV care can significantly improve patient outcomes, generate substantial public health impact by decreasing morbidity and death in settings with a high burden of HIV and TB.</description><subject>Acquired immune deficiency syndrome</subject><subject>AIDS</subject><subject>AIDS treatment</subject><subject>Anti-HIV Agents - therapeutic use</subject><subject>Anti-Retroviral Agents - therapeutic use</subject><subject>Antitubercular Agents - therapeutic use</subject><subject>Care and treatment</subject><subject>CD4-Positive T-Lymphocytes - microbiology</subject><subject>CD4-Positive T-Lymphocytes - virology</subject><subject>Coinfection - complications</subject><subject>Coinfection - epidemiology</subject><subject>Coinfection - microbiology</subject><subject>Coinfection - virology</subject><subject>Fatalities</subject><subject>Health</subject><subject>HIV</subject><subject>HIV infections</subject><subject>HIV Infections - complications</subject><subject>HIV Infections - epidemiology</subject><subject>HIV Infections - microbiology</subject><subject>HIV Infections - virology</subject><subject>HIV patients</subject><subject>Human immunodeficiency virus</subject><subject>Humans</subject><subject>Morbidity</subject><subject>Mortality</subject><subject>Patient outcomes</subject><subject>Review</subject><subject>Risk Factors</subject><subject>Tuberculosis</subject><subject>Tuberculosis - complications</subject><subject>Tuberculosis - epidemiology</subject><subject>Tuberculosis - microbiology</subject><subject>Tuberculosis - virology</subject><issn>0971-5916</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNp1ks1v1DAQxXMA0VK4c0KWkBCXLHa88QcHpKUCuqioEgKulpNMtt469tZ2EvHf49W2pUUgHyzZv_fGM89F8YLgxZJg-tZsh7BYf_n6TTGGFZGPimMsOSlrSdhR8TTGLcZEVlw-KY4oYRxXTBwXF-thF_xk3AbFMUxm0hbNJl2iNDYQ2tH6aCJ6jc7WP1EKoNMALiHjEmyCTsa7d2iFBuNMGWAyMD8rHvfaRnh-s58UPz59_H56Vp5ffF6frs7Ltq6xKwWpOMPLuquaBlraNayrBKVC0rpuGOO9aCpOOyF4zxtRE9CcUd31dNkJLoimJ8X7g-9ubAbo2vyqoK3aBTPo8Et5bdTDG2cu1cZPiolKcs6zwZsbg-CvR4hJDSa2YK124MeoKkowJwJznNFXf6FbPwaX28sU5hTnYco_1EZbUMb1Ptdt96ZqxTClnDC5zNTiH1ReHQym9Q56k88fCPBB0AYfY4D-rkeC1T54tQ9e3Qs-S17en82d4Db1DHw4ALO3CUK8suMMQWX2yvn5v8aKUKJu_wv9DZ3Dwu8</recordid><startdate>20190801</startdate><enddate>20190801</enddate><creator>Naidoo, Kogieleum</creator><creator>Rampersad, Sanisha</creator><creator>Karim, Salim</creator><general>Wolters Kluwer India Pvt. 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Treatment integration is a key in reducing mortality in patients with HIV-TB co-infection. However, this opportunity to improve outcomes of both infections is often missed or poorly implemented. Challenges in TB-HIV treatment integration range from complexities involving clinical management of co-infected patients to obstacles in health service-organization and prioritization. This is evident in high prevalence settings such as in sub-Saharan Africa where TB-HIV co-infection rates reach up to 80 per cent. This review discusses published literature on clinical trials and cohort studies of strategies for TB-HIV treatment integration aimed at reducing co-infection mortality. Studies published since 2009, when several treatment guidelines recommended treatment integration, were included. A total of 43 articles were identified, of which a total of 23 observational studies and nine clinical trials were informative on TB-HIV treatment integration. The data show that the survival benefit of AIDS therapy in patients infected with TB can be maximized among patients with advanced immunosuppression by starting antiretroviral therapy (ART) soon after TB treatment initiation, i.e. in patients with CD4+ cell counts <50 cells/μl. However, patients with greater CD4+ cell counts should defer initiation of ART to no less than eight weeks after initiation of TB treatment to reduce the occurrence and extent of immune reconstitution disease and subsequent hospitalization. Addressing operational challenges in integrating TB-HIV care can significantly improve patient outcomes, generate substantial public health impact by decreasing morbidity and death in settings with a high burden of HIV and TB.</abstract><cop>India</cop><pub>Wolters Kluwer India Pvt. Ltd</pub><pmid>31670268</pmid><doi>10.4103/ijmr.IJMR_660_19</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Acquired immune deficiency syndrome AIDS AIDS treatment Anti-HIV Agents - therapeutic use Anti-Retroviral Agents - therapeutic use Antitubercular Agents - therapeutic use Care and treatment CD4-Positive T-Lymphocytes - microbiology CD4-Positive T-Lymphocytes - virology Coinfection - complications Coinfection - epidemiology Coinfection - microbiology Coinfection - virology Fatalities Health HIV HIV infections HIV Infections - complications HIV Infections - epidemiology HIV Infections - microbiology HIV Infections - virology HIV patients Human immunodeficiency virus Humans Morbidity Mortality Patient outcomes Review Risk Factors Tuberculosis Tuberculosis - complications Tuberculosis - epidemiology Tuberculosis - microbiology Tuberculosis - virology |
| title | Improving survival with tuberculosis & HIV treatment integration: A mini-review |
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