DURBAN, South Africa – About 30 percent of TB/HIV patients die within 12 months of starting TB treatment. Efforts to reduce the risk of death among these patients has focused primarily on accelerating start of HIV treatment. In a trial discussed Wednesday, researchers explored whether changes in TB treatment could improve the odds of survival for these patients. The trial results, reported by Dr. Corrine Simone Merle from the London School of Hygiene and Tropical Medicine Wednesday, demonstrated that increasing patients’ rifampicin dosage along with the other TB medications and providing antiretroviral therapy within 8 weeks of starting TB treatment reduced the risk of early death among co-infected patients.
The RAFA trial, conducted in Benin, Senegal and Guinea randomized nearly 800 patients who were not receiving antiretroviral therapy to three treatment regimens — standard TB treatment with antiretroviral therapy provided at week two, standard TB treatment with antiretroviral treatment provided at week eight, and TB treatment with high dose rifampicin provided in the initial TB treatment phase with antiretroviral therapy provided at week eight.
The differences in the risk of death during the one year period following the start of TB treatment were not significantly different among the three groups, except for patients with immune cell — or CD4 — counts under 100. For these patients the risk of death was reduced by 96 percent compared to 91 percent among the two week HIV treatment start group with standard TB therapy, and 89 percent among those that started antiretroviral therapy at 8 weeks after the initiation of standard TB treatment.
Dr. Miller concluded that more research is needed, but more aggressive TB treatment using higher doses of rifampicin in addition to antiretroviral therapy could reduce deaths.