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• W2056553570 abstract "Mortality among people co-infected with HIV and tuberculosis could be halved if antiretroviral therapy (ART) and tuberculosis treatment were initiated at the same time, a South African study has shown. Up to 10 000 lives a year can be saved if co-infected patients start on ART earlier, says principal investigator Salim Abdool Kariem (Centre for the AIDS Programme of Research in South Africa [CAPRISA], Durban). The fi ndings should encourage implementation of a combined treatment approach globally, say researchers, and the monitoring of patients receiving combined treatment should become a standard indicator in AIDS treatment programmes. At present tuberculosis is treated fi rst and then HIV mostly after 6 months of tuberculosis treatment is completed. This is because of concerns about drug interaction, immune reconstitution, drug tolerability, and the burden of having to take too many pills. The SAPIT (Starting Antiretrovirals at Three Points in Tuberculosis Therapy) trial, an open-label randomised controlled trial undertaken by CAPRISA, announced interim fi ndings at a press conference in Durban in September, and according to researchers represent the fi rst clinical evidence worldwide showing that integrating tuberculosis and HIV treatment reduces mortality. HIV/tuberculosis co-infected patients with CD4 counts of less than 500 cells per μL were enrolled into the study in Durban up to July, 2008. Patients were assigned randomly to receive ART together with their tuberculosis treatment (integrated treatment arm; 431 patients) and were compared with patients assigned to receive ART upon completion of tuberculosis treatment (sequential treatment arm; 214 patients). 26 patients in the sequential treatment arm died (mortality rate 11·6 per 100 person-years) compared with 24 patients who died in the integrated treatment arm (mortality rate 5·1 per 100 person-years). Results showed deaths were 55% lower in patients who started taking AIDS drugs within 6 months. As a result, the study’s independent safety monitoring committee has recommended that the sequential arm of the trial be stopped and that ART be initiated in this group as soon as possible. The two subgroups within the integrated treatment arm (early tuberculosis-HIV treatment and post-intensive phase tuberculosisHIV treatment) will continue as per protocol. Kariem told TLID that researchers had an ethical responsibility to share information at this stage. Peter Piot, UNAIDS Executive Director, said: “These important results show that a ‘two diseases, one patient, one response’ integrated approach to tuberculosis/HIV treatment avoids unnecessary deaths from tuberculosis”. Paul Nunn (Stop TB Department, WHO, Geneva, Switzerland) commented, “The results to date clearly show the urgent necessity to make ART available to HIV-infected patients with tuberculosis worldwide”." @default.
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• W2056553570 date "2008-11-01" @default.
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• W2056553570 title "Trial finds simultaneous HIV/tuberculosis treatment beneficial." @default.
• W2056553570 doi "https://doi.org/10.1016/s1473-3099(08)70245-7" @default.
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