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Therapeutic effectiveness on early and delayed treatment of antiretroviral in TB-HIV patients: a literature review

Abstract

Introduction: Indonesia is one of the countries with a high TB-HIV prevalence. Antiretroviral treatment (ART) is only being administered to approximately 42% of TB-HIV patients. The low utilization of ART can be attributed, in part, to the delayed initiation of treatment. Nonetheless, starting ART in these people at an early stage poses risks, owing to the increased likelihood of drug-drug interactions and the manifestation of Immune Reconstitution Inflammatory Syndrome (IRIS) side effects when combined with anti-TB medication. Postponing ART, on the other hand, can hasten illness progression and increase the risk of death.

Methods: A literature review was conducted to assess the effects of early ART (within four weeks of getting anti-TB) against delayed ART initiation (at least eight weeks after receiving anti-TB) in individuals co-infected with TB and HIV. The data was obtained by a comprehensive electronic search using the PubMed and Science Direct databases.

Results: The findings of our study suggest that there was no statistically significant disparity in mortality rates between the early ART group and the delayed ART group. The initial ART cohort had a markedly elevated susceptibility to encountering an IRIS occurrence, particularly among individuals with a CD4 count below 50 cells per cubic millimeter.

Conclusion: In summary, the strategy of delaying the initiation of ART in patients co-infected with TB-HIV is seen as preferable when compared to the approach of early treatment. The frequency of IRIS events is a significant determinant in determining the optimal timing of ART initiation in individuals co-infected with TB-HIV.

Section

References

  1. Kemenkes RI. Profil Kesehatan Indonesia Tahun 2019, Kementrian Kesehatan Republik Indonesia. 2019.
  2. World Health Organization. Global Tuberculosis Report 2019. 2020.
  3. Müller M, Wandel S, Colebunders R, Attia S, Furrer H, Egger M; IeDEA Southern and Central Africa. Immune reconstitution inflammatory syndrome in patients starting antiretroviral therapy for HIV infection: a systematic review and meta-analysis. Lancet Infect Dis. 2010;10(4):251-61. doi: https://doi.org/10.1016/S1473-3099(10)70026-8.
  4. Cevaal PM, Bekker LG, Hermans S. TB-IRIS pathogenesis and new strategies for intervention: Insights from related inflammatory disorders. Tuberculosis (Edinb). 2019; 118: 101863. doi: https://doi.org/10.1016/j.tube.2019.101863
  5. WHO. WHO policy on collaborative TB / HIV activities Guidelines for national programmes and other stakeholders. 2012; 330: 2–36. doi: 23586124.
  6. Armstrong WS. The immune reconstitution inflammatory syndrome: a clinical update. Curr Infect Dis Rep. 2013;15(1):39-45. doi: https://doi.org/10.1007/s11908-012-0308-y.
  7. Abdool Karim SS, Naidoo K, Grobler A. Integration of antiretroviral therapy with tuberculosis treatment. N Engl J Med. 2011;365(16):1492-1501. doi: https://doi.org/10.1056/NEJMoa1014181.
  8. Blanc FX, Sok T, Laureillard D. Earlier versus later start of antiretroviral therapy in HIV-infected adults with tuberculosis. N Engl J Med. 2011;365(16):1471-1481. doi: https://doi.org/10.1056/NEJMoa1013911.
  9. Havlir DV, Kendall MA, Ive P. Timing of antiretroviral therapy for HIV-1 infection and tuberculosis. N Engl J Med. 2011;365(16):1482-1491. doi: https://doi.org/10.1056/NEJMoa1013607.
  10. Yang CH, Chen KJ, Tsai JJ. The impact of HAART initiation timing on HIV-TB co-infected patients, a retrospective cohort study. BMC Infect Dis. 2014;14:304. doi: https://doi.org/10.1186/1471-2334-14-304.
  11. Amogne W, Aderaye G, Habtewold A. Efficacy and Safety of Antiretroviral Therapy Initiated One Week after Tuberculosis Therapy in Patients with CD4 Counts < 200 Cells/μL: TB-HAART Study, a Randomized Clinical Trial. PLoS One. 2015;10(5):e0122587. doi: https://doi.org/10.1371/journal.pone.0122587.
  12. Kendon MA, Knight S, Ross A, Giddy J. Timing of antiretroviral therapy initiation in adults with HIV-associated tuberculosis: outcomes of therapy in an urban hospital in KwaZulu-Natal. S Afr Med J. 2012;102(12):931-935. doi: https://doi.org/10.7196/samj.5574.
  13. Manosuthi W, Mankatitham W, Lueangniyomkul A. Time to initiate antiretroviral therapy between 4 weeks and 12 weeks of tuberculosis treatment in HIV-infected patients: results from the TIME study. J Acquir Immune Defic Syndr. 2012;60(4):377-383. doi: https://doi.org/10.1097/QAI.0b013e31825b5e06.
  14. Sinha S, Shekhar RC, Singh G. Early versus delayed initiation of antiretroviral therapy for Indian HIV-Infected individuals with tuberculosis on antituberculosis treatment. BMC Infect Dis. 2012;12:168. doi: https://doi.org/10.1186/1471-2334-12-168.
  15. Mfinanga SG, Kirenga BJ, Chanda DM. Early versus delayed initiation of highly active antiretroviral therapy for HIV-positive adults with newly diagnosed pulmonary tuberculosis (TB-HAART): a prospective, international, randomised, placebo-controlled trial [published correction appears in Lancet Infect Dis. 2014;14(7):548]. Lancet Infect Dis. 2014;14(7):563-571. doi: https://doi.org/10.1016/S1473-3099(14)70733-9.

How to Cite

Rahardjo, D. N., Santoso, S. S. ., Andrajati, R. ., Sartika, R. A. D. ., & Wahjudi, M. . (2024). Therapeutic effectiveness on early and delayed treatment of antiretroviral in TB-HIV patients: a literature review. Indonesia Journal of Biomedical Science, 17(2), 306–313. https://doi.org/10.15562/ijbs.v17i2.515

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Dian Natasya Rahardjo
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Stefannie Sherine Santoso
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Retnosari Andrajati
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Ratu Ayu Dewi Sartika
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Mariana Wahjudi
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