Times of initiation of antiretroviral therapy in patients with tuberculosis and human immunodeficiency virus co-infection with CD4 count less than 350 cells/mm3
To examine the mortality rates of various initiation times of antiretroviral therapy (ART) after starting tuberculosis treatment.
We conducted a retrospective cohort study using medical records of outpatients with the diagnosis of TB/HIV co-infection in Khon Kaen Hospital, Thailand between January 2007 and August 2017. We included the patients who started tuberculosis treatment and various times of starting ART with CD4 count less than 350 cells/mm3. We separated patients into 3 groups by the time of initiated ART starting within the first 4 weeks, 5 to 8 weeks, and 9 to12 weeks after starting tuberculosis treatment. We compared the risk of all-cause mortality within 1 year after start tuberculosis treatment among three groups as our primary outcome. Our secondary outcomes were sputum conversion at 2 months after starting tuberculosis treatment and rate of CD4 count increasing in 1 year after tuberculosis treatment.
A total of 132 patients with TB/HIV co-infection and CD4 count less than 350 cells/mm3 were included in the study; 62 patients started ART within the first 4 weeks after TB treatment, 45 patients started in 5 to 8 weeks and 25 patients started in 9 to 12 weeks. The primary outcome was reached by 1 (2%) patient in the first group, 2 (8%) patients in the second group, and 1 (4%) patient in the third group. (relative risk [RR], 2.76, 95% CI, 0.26 to 29.47 and RR, 2.48, 95% CI, 0.16 to 38.13). Only 28 of 132 patients (21%) had been recorded data on sputum conversion at 2 months after tuberculosis treatment, the result showed no significant difference in improving sputum conversion between starting ART at 5 to 8 weeks and starting ART within the first 4 weeks (RR, 1.30, 95% CI, 0.77 to 2.21). CD4 level increasing rates among the three groups were not significantly different (mean difference (MD), 2556.79, 95% CI, -1011.56 to 6125.14 and MD, 86.67, 95% CI, -1333.69 to 1507.04).
The study showed no significant difference between mortality rate and various initiation time of ART after start tuberculosis treatment.