期刊
INTERNATIONAL JOURNAL OF TUBERCULOSIS AND LUNG DISEASE
卷 19, 期 1, 页码 50-57出版社
INT UNION AGAINST TUBERCULOSIS LUNG DISEASE (I U A T L D)
DOI: 10.5588/ijtld.14.0217
关键词
human immunodeficiency virus; TB incidence; CD4 lymphocyte count; HIV-TB; ART
资金
- National Institute of Allergy and Infectious Diseases at the National Institutes of Health [A1098627, A158257]
SETTING: Port-au-Prince, Haiti. OBJECTIVE: To determine long-term effects of early vs. delayed initiation of antiretroviral therapy (ART) on immune recovery and tuberculosis (TB) risk in human immunodeficiency virus (HEY) infected individuals. DESIGN: Open-label randomized controlled trial of immediate ART in HIV-infected adults with CD4 counts between 200 and 350 cells/mm(3) vs. deferring ART until the CD4 count was <200 cells/mm(3). The primary comparisons were CD4 counts over time and risk for incident TB, with 5 years of follow-up. RESULTS: A total of 816 participants were enrolled, with 408 in each treatment arm. The early treatment group started ART within 2 weeks, while the deferred treatment group started ART a median of 1.3 years after enrollment. After 5 years, the mean CD4 count in the early treatment group was significantly higher than in the deferred treatment group (496 cells/mm3, 95% confidence interval [CI ] 477-515 vs. 373 cells/mm3, 95%CI 357-389; P < 0.0001). TB risk was higher in the deferred treatment group (unadjusted HR 2.41, 95 %CI 1.56-3.74; P < 0.0001) and strongly correlated with lower CD4 counts in time-dependent multivariate analysis. CONCLUSION: Delays in ART initiation for HIV-infected adults with CD4 counts of 200-350 cells/mm3 can result in long-term immune dysfunction and persistent increased risk for TB.
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