People living with HIV achieve rates of survival from drug-resistant tuberculosis similar to those of people without the virus, when they receive immediate access to antiretroviral medicine along with their tuberculosis treatment, a study following more than 200 patients in South Africa found. The findings, pointing to the critical benefits of “aggressive initiation” of life-saving treatment for HIV, are important to preserving progress against both diseases, the authors of a study published in Clinical Infectious Diseases note.
Patients with HIV have historically borne the brunt of tuberculosis that does not respond to the most common, least toxic and shortest drug regimens, with death rates among coinfected individuals from drug-resistant disease approaching 50 percent in data collected before the widespread availability of antiretroviral medicines. While research has found antiretroviral treatment evened the odds for survival among people with HIV and tuberculosis that was responsive to first line treatment, the impacts of combining antiretroviral treatment with the much lengthier and more complicated treatment regimens for drug-resistant tuberculosis, which include daily painful injections and can bring permanently debilitating side effects, had not been measured, the authors note.
Researchers, led by Dr. James Brust of Albert Einstein College of Medicine, followed 150 patients with HIV and 56 uninfected patients, all of whom had been diagnosed with multidrug-resistant tuberculosis between 2011 and 2013. Survival rates between the two groups differed — at 85 percent among the patients with HIV, and 94 percent among the uninfected patients — but researchers noted that an already severely damaged immune system, reflected in a CD4 — or immune cell — count under 100, posed the greatest threat to survival among those with HIV.