The effect of tuberculosis treatment on virologic and immunologic response to combination antiretroviral therapy among South African children

Soeters, Heidi M.; Sawry, Shobna; Moultrie, Harry; Van Rie, Annelies

doi:10.1097/QAI.0000000000000284

Title

The effect of tuberculosis treatment on virologic and immunologic response to combination antiretroviral therapy among South African children

Author

Soeters, Heidi M.

Sawry, Shobna

Moultrie, Harry

Van Rie, Annelies

Abstract

Background: Many HIV-infected children are diagnosed with tuberculosis (TB), but the effect of TB treatment on virologic and immunologic response to combination antiretroviral therapy (cART) is not well documented. Methods: Secondary analysis of a prospective cohort of cART-naive HIV-infected South African children aged 0-8 years initiating cART to assess the effect of TB treatment at the time of cART initiation on virologic suppression (HIV RNA < 50 copies/mL), virologic rebound (HIV RNA > 1000 copies/mL after suppression), and CD4 cell percent (CD4%) increase during the first 24 months of cART. Results: Of 199 children (median age 2.1 years), 92 (46%) were receiving TB treatment at cART initiation. Children receiving and not receiving TB treatment at cART initiation had similar median baseline HIV RNA (5.4 vs. 5.6 copies/mL), median time to virologic suppression (6.2 months in each group, adjusted hazard ratio, 1.36, 95% confidence interval: 0.94 to 1.96), and rates of virologic rebound by 24 months (23% vs. 24%, adjusted hazard ratio 1.53, 95% confidence interval: 0.71 to 3.30). Children on TB treatment had significantly lower median CD4% at baseline (15.3% vs. 18.8%, P < 0.01) and during the first 12 months of cART but experienced similar median increases in CD4% at 6 months (9.9% vs. 9.6%), 12 months (14.2% vs. 11.9%), and 24 months of cART (14.5% vs. 14.2%). Exploratory analyses suggest that children receiving lopinavir/ritonavir-based cART and TB treatment may have inferior virologic and immunologic response compared with children receiving efavirenz-based cART. Conclusions: Receiving TB treatment at the time of cART initiation did not substantially affect virologic or immunologic response to cART in young children.

Language

English

Source (journal)

JAIDS. - Philadelphia, Pa

Publication

Philadelphia, Pa : 2014

ISSN

1525-4135

DOI

10.1097/QAI.0000000000000284

Volume/pages

67 :2 (2014) , p. 136-144