Delayed antiretroviral therapy despite integrated treatment for tuberculosis and HIV infection

• Published in: The international journal of tuberculosis and lung disease Vol. 18; no. 6; pp. 694 - 699
• Main Authors: Patel, M. R., Nana, M., Yotebieng, M., Tabala, M., Behets, F., Van Rie, A.
• Format: Journal Article
• Language: English
• Published: Paris International Union Against Tuberculosis and Lung Disease 01-06-2014; International Union against Tuberculosis and Lung Disease
• Subjects: Adult; Anti-HIV Agents - administration & dosage; Antitubercular Agents - administration & dosage; Bacterial diseases; Biological and medical sciences; CD4 Lymphocyte Count; Chi-Square Distribution; Coinfection; Delay; Delivery of Health Care, Integrated; Democratic Republic of the Congo - epidemiology; Drug Administration Schedule; Health Services Accessibility; HIV; HIV Infections - diagnosis; HIV Infections - drug therapy; HIV Infections - epidemiology; Human bacterial diseases; Human immunodeficiency virus 1; Human immunodeficiency virus 2; Human viral diseases; Humans; Immunodeficiencies; Immunodeficiencies. Immunoglobulinopathies; Immunopathology; Infectious diseases; Integration; Logistic Models; Male; Medical sciences; Middle Aged; Mycobacterium; Odds Ratio; Pneumology; Predictive Value of Tests; Predictors; Prospective Studies; Risk Factors; Time Factors; Time-to-Treatment; Treatment Outcome; Tuberculosis - diagnosis; Tuberculosis - drug therapy; Tuberculosis - epidemiology; Tuberculosis and atypical mycobacterial infections; Viral diseases; Viral diseases of the lymphoid tissue and the blood. Aids; Democratic Republic of the Congo; predictors; Immunopathology; Antiretroviral agent; Integration; Respiratory disease; Prediction; Retroviridae; AIDS; Mycobacterial infection; Immune deficiency; Lentivirus; Delay; TB; Infection; Virus; Chemotherapy; Treatment; Tuberculosis; HIV; Viral disease; Bacteriosis; Antiviral; Human immunodeficiency virus; Predictive factor
• ISSN: 1027-3719; 1815-7920
• DOI: 10.5588/ijtld.13.0807

SETTING:Five primary health care clinics in Kinshasa, Democratic Republic of Congo. OBJECTIVE:To examine timing and predictors of delayed initiation of
antiretroviral therapy (ART) during anti-tuberculosis treatment. DESIGN:Prospective observational cohort of adult patients receiving integrated treatment for tuberculosis (TB) and human immunodeficiency virus (HIV)
who are expected to initiate ART at 1 month if CD4 count is <100 cells/mm3 or if patient is World Health Organization (WHO) Clinical Stage 4 for reasons other than extra-pulmonary TB, at 2 months if CD4 count is 100-350 cells/mm3, or at completion of anti-tuberculosis
treatment if subsequently CD4 count is 350 cells/mm3 or patient has WHO Clinical Stage 4. RESULTS:Of 492 patients, 235 (47.8%) experienced delayed initiation of ART: 171 (72.8%) initiated ART late,
after a median delay of 12 days (interquartile range [IQR] 4-27) and 64 (27.2%) never initiated ART. Contraindication to any antiretroviral drug (aOR 2.91, 95%CI 1.22-6.95), lower baseline CD4 count (aOR 1.20, 95%CI 1.08-1.33/100 cells/mm3), TB drug intolerance
(aOR 1.93, 95%CI 1.23-3.02) and non-disclosure of HIV infection (aOR 1.50, 95%CI 1.03-2.18) predicted delayed ART initiation. CONCLUSION:Despite fully integrated treatment, half of all patients experienced
delayed ART initiation. Pragmatic approaches to ensure timely ART initiation in those at risk of delayed ART initiation are needed.