Details

Autor(en) / Beteiligte

• Török, M. Estee
• Yen, Nguyen Thi Bich
• Chau, Tran Thi Hong
• Mai, Nguyen Thi Hoang
• Phu, Nguyen Hoan
• Mai, Pham Phuong
• Dung, Nguyen Thi
• Van Vinh Chau, Nguyen
• Bang, Nguyen Duc
• Tien, Nguyen Anh
• Minh, N. H.
• Hien, Nguyen Quang
• Thai, Phan Vuong Khac
• Dong, Doan The
• Anh, Do Thi Tuong
• Thoa, Nguyen Thi Cam
• Hai, Nguyen Ngoc
• Lan, Nguyen Ngoc
• Lan, Nguyen Thi Ngoc
• Quy, Hoang Thi
• Dung, Nguyen Huy
• Hien, Tran Tinh
• Chinh, Nguyen Tran
• Simmons, Cameron Paul
• Jong, Menno de
• Wolbers, Marcel
• Farrar, Jeremy James

Titel

Timing of Initiation of Antiretroviral Therapy in Human Immunodeficiency Virus (HIV)—Associated Tuberculous Meningitis

Ist Teil von

• Clinical infectious diseases, 2011-06, Vol.52 (11), p.1374-1383

Ort / Verlag

Oxford: Oxford University Press

Erscheinungsjahr

2011

Link zum Volltext

Quelle

Oxford Journals 2020 Medicine

Beschreibungen/Notizen

• Background. The optimal time to initiate antiretroviral therapy (ART) in human immunodeficiency virus (HIV)—associated tuberculous meningitis is unknown. Methods. We conducted a randomized, double-blind, placebo-controlled trial of immediate versus deferred ART in patients with HIV-associated tuberculous meningitis to determine whether immediate ART reduced the risk of death. Antiretroviral drugs (zidovudine, lamivudine, and efavirenz) were started either at study entry or 2 months after randomization. All patients were treated with standard antituberculosis treatment, adjunctive dexamethasone, and prophylactic co-trimoxazole and were followed up for 12 months. We conducted intention-to-treat, perprotocol, and prespecified subgroup analyses. Results. A total of 253 patients were randomized, 127 in the immediate ART group and 126 in the deferred ART group; 76 and 70 patients died within 9 months in the immediate and deferred ART groups, respectively. Immediate ART was not significantly associated with 9-month mortality (hazard ratio [HR], 1.12; 95% confidence interval [CI],.81-1.55; P = .50) or the time to new AIDS events or death (HR, 1.16; 95% CI,.87-1.55; P = .31). The percentage of patients with severe (grade 3 or 4) adverse events was high in both arms (90% in the immediate ART group and 89% in the deferred ART group; P = .84), but there were significantly more grade 4 adverse events in the immediate ART arm (102 in the immediate ART group vs 87 in the deferred ART group; P = .04). Conclusions. Immediate ART initiation does not improve outcome in patients presenting with HIV-associated tuberculous meningitis. There were significantly more grade 4 adverse events in the immediate ART arm, supporting delayed initiation of ART in HIV-associated tuberculous meningitis.