Introduction: Interaction between HAART and TB Treatment TB and HIV: A Deadly Partnership - PowerPoint PPT Presentation

Loading...

PPT – Introduction: Interaction between HAART and TB Treatment TB and HIV: A Deadly Partnership PowerPoint presentation | free to view - id: fbd2d-YmNlN



Loading


The Adobe Flash plugin is needed to view this content

Get the plugin now

View by Category
About This Presentation
Title:

Introduction: Interaction between HAART and TB Treatment TB and HIV: A Deadly Partnership

Description:

TB Prevention in HIV-infected/AIDS and concomitant HAART and TB treatment. TB Prevention: ... Concomitant TB Treatment and HAART. Duration of TB therapy in ... – PowerPoint PPT presentation

Number of Views:74
Avg rating:3.0/5.0
Slides: 7
Provided by: FIC2
Category:

less

Write a Comment
User Comments (0)
Transcript and Presenter's Notes

Title: Introduction: Interaction between HAART and TB Treatment TB and HIV: A Deadly Partnership


1
Introduction Interaction between HAART and TB
TreatmentTB and HIV A Deadly Partnership
  • Jean William Pape MD
  • Professor of Medicine
  • Division of International Medicine and Infectious
    Diseases
  • Weill Cornell Medical College, New York, NY
  • Director, Centres GHESKIO, Port-au-Prince, Haiti
  • AIDS 2008 Poster Discussion
  • Skills Building Room 10
  • August 4, 2008
  • 100-200PM

2
TB Prevention in HIV-infected/AIDS and
concomitant HAART and TB treatment
  • TB Prevention
  • INH preventive therapy (IPT) reduces risk of TB
    by 62 in PPD and by 36 overall (Woldehanna and
    Volmink, Cochrane Review 2006)
  • HAART reduces the risk of TB (Jones JL et al Int
    J Tuberc lung Dis 4 (11) 1026-1031)
  • What about if provided together?
  • TB Therapy and HAART
  • Duration of TB treatment in patients on HAART
  • Side effects
  • Immune Reconstitution Syndrome
  • Timing of HAART initiation in patients on TB
    treatment

3
Prevention of TB in HIV-infected patients
TB Rates in 11,026 HIV Patients with Access to
ART and IPT in Rio de Janeiro Golub et al.,
AIDS 2007, 211441-1448
4
Concomitant TB Treatment and HAART
  • Duration of TB therapy in patients on HAART
    unknown
  • 6 months versus 9-12 months (WHO (206)
    Antiretroviral therapy for HIV infection in
    adults in resources constrained settings
    Perriens JH et al N Engl J Med 1995 332 (12)
    779-784)
  • 6 months INH (Fitzgerald DW et al Lancet
    20003561470-74).
  • Toxicity
  • PIs and NNRTI and rifamycins
  • Risk of development of the immune reconstitution
    syndrome (IRS)
  • Administration of HAART within the first 2 months
    of starting anti TB treatment is an independent
    predictor of IRIS. (Navas E et al Arch.Int Med
    2002 16297-9)
  • Led to the delay in initiation of HAART in
    patients started on anti-TB treatment
  • Optimal timing of HAART initiation unknown Many
    on-going studies to determine whether early
    initiation of ART improves survival as compared
    with delayed ART
  • GHESKIO CIPRA study Completed enrollment of 816
    AIDS patients randomized to early HAART
    initiation (US/European guidelines) versus
    deferred HAART initiation based on WHO criteria
  • ACTG 5221 Immediate Versus Deferred Initiation
    of HAART for AIDS patients treated for TB
    Tuberculosis with CD4 lt200 Cells/mm 3

5
Survival of 201 Patients with AIDS and TB on
anti-TB treatment and HAART according to timing
of TB
  • Mortality ()
  • TB at HAART initiation11
  • TB gt 3 months after HAART2
  • TB lt3 months after HAART 27

Koenig S, Fitzgerald D, Pape JW, Centres GHESKIO,
Haiti
6
HAART and TB therapy Summary
  • The use of both IPT and HAART in HIV-infected
    patients reduces the incidence of TB and is
    recommended
  • Concomitant administration of HAART and anti-TB
    meds is associated with
  • High pills burden
  • Higher rate of side effects (PIs and NNRTI and
    rifamycins),
  • Immune reconstitution Syndrome (IRS)
  • Unknown
  • Optimal duration of TB therapy in AIDS patients
    on HAART
  • Best timing for starting HAART in AIDS patients
    with TB
  • TB mortality in Haiti found higher during first 3
    months of HAART and could be associated with
    early high mortality seen in resources
    constrained settings
  • MDRTB and XDRTB when associated with HIV
    increased considerably the mortality rate
About PowerShow.com