Responses to TB treatment in HIV positive and HIV negative patients in the UK

A interesting case note review of patients at the Royal Free Hospital in London compared 115 people with active HIV/TB coinfection to 114 unselected HIV negative TB patients treated over the same time period to study the adverse events profile when both HAART and TB medication are used simultaneously.

TB coinfection is a increasing concern in many UK clinics, particularly in late presenters with advanced HIV disease (CD4 <100 cells/mm³), requiring specialist care management.

Ronan Breen and colleagues found that anti-TB medication had a similar adverse event profile in both groups and that although HAART was associated with an increase in such events these did not lead to more treatment interruptions.

Median duration of TB treatment was 6 months (range 3-36 months) and HAART was started a median of 2 months after TB treatment (range 0-7 months). Three quarters of the HIV positive patients received additional HIV treatment at some point. Rifamycin-based regimens were used in 98% cases.TB treatment was interrupted in 13 HIV positive and 10 HIV negative patients, largely due to hepatic toxicity (8 cases in each group). Other grade 3/4 side effects were higher in the HIV-positive group: peripheral neuropathy 14% vs 4%; rash 10% vs 3%; persistent vomiting 9% vs 3% but this did not result in increased interruption of TB medication. HAART was stopped in 6/84 (7%) patients due to poor adherence (2); treatment failure (3), IRIS (1), and 15 regimens were modified, largely to duce toxicity.

Importantly, a higher proportion of coinfected patients than HIV negative patients successfully completed their course of TB treatment (110/115 vs 99/114).

Breen R, Miller R, Ballinger J et al. Similar profile of adverse events during treatment for tuberculosis in patients with and without HIV co-infection. 7th ICDTHI,14-18 Nov, 2004, Glasgow. Abstract PL9.3.