Safety and effectiveness of HAART in tuberculosis-HIV co-infected patients in Brazil.

TUBERCULOSIS (TB) is a common complication of human immunodefficiency virus (HIV) infection and a leading cause of death. One quarter of TB deaths globally occur among HIV-infected individuals. In 2009, there were an estimated 1.12 million HIV-infected TB patients globally, and 380 000 people died of HIV-associated TB.1,2 Since the advent of highly active antiretroviral therapy (HAART) for the treatment of HIV-infected persons, the incidence of HIV-related opportunistic infections, including TB, has markedly decreased;3,4 however, TB still occurs frequently among HIV-infected people and remains a major cause of death in developing countries.5 Concomitant treatment for TB and HIV is clinically challenging and complex due to the high pill burden, variable drug absorption, immune reconstitution inflammatory syndrome (IRIS), overlapping toxicities, drug interactions and non-adherence to treatment.6–12 Drug interactions between rifampin (RMP) and protease inhibitors (PIs) and non-nucleoside reverse transcriptase inhibitors (NNRTIs) may potentially result in the loss of antiviral efficacy and the development of viral resistance.13–15 It is clear that HAART reduces mortality and the risk of other acquired immunedefficiency syndrome (AIDS) defining illnesses, and starting it during anti-tuberculosis treatment improves outcomes, as reported since 2001.6,16–18 Two recent studies conducted in Africa concluded that the initiation of HAART regimen with efavirenz during anti-tuberculosis treatment significantly reduced mortality, that rates of adverse events (AE) were similar if anti-tuberculosis treatment and ART were concomitant or sequential,19 and that early HAART initiation during anti-tuberculosis treatment reduced mortality in individuals with low CD4 counts.20 Our study was carried out to assess the impact of HAART on survival and the risk of AE during anti-tuberculosis treatment in Brazilian HIV-infected patients in a hospital setting where both TB and HIV constitute a high public health burden. Our results corroborate those from previous trials conducted in TB-HIV co-infected patients.