HIV, Tuberculosis Should be Treated Together-Study. 25/2/10
Dual treatment pays off with a 56 percent reduction in deaths from all causes, the large South African study published in the New England Journal of Medicine showed.
By Gene Emery
25 February 2010
Treating tuberculosis and the AIDS virus simultaneously saves more than twice as many lives compared with attacking TB first, researchers reported on Wednesday.
Dual treatment pays off with a 56 percent reduction in deaths from all causes, the large South African study published in the New England Journal of Medicine showed.
About 33 million people worldwide are infected with HIV, the AIDS virus, and 9.2 million have recently been diagnosed with lung-destroying tuberculosis, according to the World Health Organization.
In many cases, HIV's suppression of the immune system allows the deadly tuberculosis bacterium to thrive. In South Africa, about 73 percent of TB patients also have HIV.
Yet doctors have been reluctant to treat both at once, often choosing to go after TB first. They have been concerned about drug interactions, overlapping side effects and the large number of pills that patients have to take each day.
"You add to the risk of side effects very substantially," Dr. Salim Abdool Karim of the University of KwaZulu-Natal, in Durban, South Africa, said in a telephone interview.
Treating TB requires months of antibiotics. HIV is incurable and patients must take cocktails of antiviral drugs for life.
"What you don't want is patients stopping the TB drugs," Karim said. "So most doctors treating a patient with TB and HIV prefer to finish with the TB drugs and then start on the antiretroviral drugs."
They tested more than 600 patients with both TB and HIV.
The death rate was 5.4 percent a year for the volunteers who got treatment for both infections, compared with 12.1 percent for those whose TB was treated first, with HIV therapy beginning about six months later.
The results were so convincing that they already prompted the WHO to change its guidelines to call for treating both conditions at the same time.
The findings also changed national policy in South Africa, Karim said.
As a practical matter, said Karim, TB treatment usually begins a few weeks before HIV therapy because TB treatment is started right off. It can take a week to get the test results for HIV, and time is needed to bring patients up to speed about the complexities of taking the AIDS drugs.