The following post is by HIVMA Executive Director Andrea Weddle, reporting from the 18th International AIDS Conference in Vienna.
In another late breaker session Thursday, French researcher Blanc presented data supporting early initiation of HIV treatment for patients co-infected with HIV/TB and suggesting it could reduce deaths in co-infected patients by 33 percent.
The results were from the CAMELIA (Cambodian early vs. late introduction of antiretrovirals) superiority trial, conducted to evaluate the preferred time for initiating HIV treatment within the context of the 2003 WHO recommendations. The recommendations called for starting TB treatment first, with HIV treatment beginning at 2 weeks or within the first two months of TB treatment initiation.
Blanc reminded attendees that there are 1.37 million incident cases of TB in HIV infected patients per year and 450,000 people with HIV die of TB every year. The updated 2010 WHO guidelines recommend starting treatment for TB first, with an initiation of antiretroviral therapy (ART) as soon as possible within 8 weeks of TB treatment initiation.
To examine the when to start ART question, the CAMELIA trial recruited 661 patients co-infected with TB and HIV with CD4<200 from May 2006 to May 2009. One study arm initiated ART two weeks after starting TB treatment, with the second arm starting ART at 8 weeks following initiation of TB treatment. The median CD4 count for both groups was 25.
The findings demonstrated a 34 percent reduction in mortality in the two-week ART initiation arm with 59 deaths in the early ART treatment arm and 90 deaths in the eight-week ART treatment arm. Blanc reported Immune Reconstitution Inflammatory Syndrome was much more common in the early ART arm but was easily managed. In both study arms, ART was extremely effective, with 95 percent of patients achieving undetectable viral loads and patients remaining adherent despite low CD4 counts at treatment initiation.
Blanc estimated initiation of ART two weeks following TB treatment initiation could prevent 150,000 of the 450,000 annual deaths attributed to TB in co-infected patients.
The presentation was based on IAC Abstract THLBB106 – A Significant enhancement in survival with (two weeks) vs. late (eight weeks) initiation of highly active antiretroviral treatment (HAART) in severely immunosupressed HIV-infected adults with newly diagnosed tuberculosis.