Receiving therapy for tuberculosis when starting a first antiretroviral therapy (ART) regimen did not affect virologic or CD4 response to that regimen in a study of 199 South African children. Responses appeared to be worse with lopinavir/ritonavir than with efavirenz in children taking TB therapy when ART began.
Although many children starting ART have TB in sub-Saharan Africa, little is known about how TB therapy affects response to ART in these children. To address that question, researchers conducted this secondary analysis of a prospective cohort study of antiretroviral-naive South African children starting their first ART.
All children were 8 years old or younger when they began ART. The researchers defined virologic suppression as HIV RNA below 50 copies/mL and virologic rebound as a viral load above 1000 copies/mL. They measured virologic response and CD4 percent change during the first 24 months of ART.
The study involved 199 children with a median age of 2.1 years. Ninety-two children (46%) were receiving TB therapy when they began ART. Pretreatment viral load did not differ significantly between children receiving and not receiving TB therapy (5.4 and 5.6 log10 copies/mL), but initial CD4 percent was significantly lower in the children on TB therapy (15.3% versus 18.8%, P < 0.01).
Median time to virologic suppression measured 6.2 months in both groups of children. Statistical analysis considering multiple factors that may affect virologic suppression determined that TB therapy when ART began did not affect chances of suppression (adjusted hazard ratio [aHR] 1.36, 95% confidence interval [CI] 0.94 to 1.96).
Rates of virologic rebound in the first 24 months of ART did not differ substantially between children on and off TB therapy when ART began (23% and 24%, aHR 1.53, 95% CI 0.71 to 3.30).
CD4 percent remained lower in children on TB therapy when ART began during the first 12 months of ART. But percentage gains were similar in children on and off TB therapy at 6 months (9.9% and 9.6%), 12 months (14.2% and 11.9%), and 24 months of ART (14.5% and 14.2%).
Exploratory analyses suggested that children receiving TB therapy and starting a lopinavir/ritonavir regimen had worse virologic and immunologic responses than children starting an efavirenz regimen.
The authors conclude that “receiving TB treatment at the time of ART initiation did not substantially affect virologic or immunologic response to ART in young children.”
Source: Heidi M. Soeters, Shobna Sawry, Harry Moultrie, Annelies Van Rie. The effect of tuberculosis treatment on virologic and immunologic response to combination antiretroviral therapy among South African children. JAIDS. 2014; 67: 136-144.
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