PMID- 17159657
OWN - NLM
STAT- MEDLINE
DCOM- 20070319
LR  - 20200930
IS  - 1525-4135 (Print)
IS  - 1525-4135 (Linking)
VI  - 44
IP  - 2
DP  - 2007 Feb 1
TI  - Timing of antiretroviral therapy initiation in tuberculosis patients with AIDS: a 
      decision analysis.
PG  - 229-34
AB  - In HIV-infected tuberculosis patients with <200 CD4 lymphocytes/mm, highly active 
      antiretroviral therapy (HAART) improves survival but can be complicated by immune 
      reconstitution inflammatory syndrome (IRIS) and drug toxicity. We conducted a 
      decision analysis in hypothetical cohorts of 1000 patients in which HAART was 
      initiated during the first 2 months of tuberculosis therapy (early) or during 
      months 2 through 6 of tuberculosis therapy (deferred) or was withheld until after 
      tuberculosis therapy (no HAART). Outcomes assessed were 1-year mortality and the 
      combined outcome of 1-year mortality, new AIDS-defining illness, severe IRIS, and 
      severe drug toxicity. There were 33, 48, and 147 deaths and 497, 501, and 501 
      combined outcome events in the early HAART, deferred HAART, and no-HAART groups, 
      respectively; most events were drug toxicity in the early and deferred groups and 
      HIV-related mortality or AIDS-defining illness in the no-HAART group. In a 2-way 
      sensitivity analysis of mortality, early HAART was favored, even with the highest 
      reported rates of IRIS (70%) and severe drug toxicity (56%). Deferred HAART was 
      favored over early HAART only if the IRIS-related mortality rate in the early 
      group exceeded 4.6%. These results support early initiation of HAART in patients 
      with AIDS, except when IRIS-related mortality rates are high.
FAU - Schiffer, Joshua T
AU  - Schiffer JT
AD  - Division of Infectious Diseases, Department of Medicine, University of 
      Washington, Seattle, USA.
FAU - Sterling, Timothy R
AU  - Sterling TR
LA  - eng
GR  - T32 AI007140/AI/NIAID NIH HHS/United States
GR  - K24AI065298/AI/NIAID NIH HHS/United States
PT  - Journal Article
PT  - Research Support, N.I.H., Extramural
PL  - United States
TA  - J Acquir Immune Defic Syndr
JT  - Journal of acquired immune deficiency syndromes (1999)
JID - 100892005
RN  - 0 (Anti-HIV Agents)
RN  - 0 (Antitubercular Agents)
SB  - IM
CIN - J Acquir Immune Defic Syndr. 2007 Sep 1;46(1):121-3; author reply 123. PMID: 
      17909319
MH  - Acquired Immunodeficiency Syndrome/*complications/*drug therapy/mortality
MH  - Anti-HIV Agents/administration & dosage/adverse effects/*therapeutic use
MH  - Antiretroviral Therapy, Highly Active
MH  - Antitubercular Agents/*therapeutic use
MH  - CD4 Lymphocyte Count
MH  - *Decision Support Techniques
MH  - Drug Administration Schedule
MH  - Humans
MH  - Survival Analysis
MH  - Time Factors
MH  - Treatment Outcome
MH  - Tuberculosis/*complications/*drug therapy
EDAT- 2006/12/13 09:00
MHDA- 2007/03/21 09:00
CRDT- 2006/12/13 09:00
PHST- 2006/12/13 09:00 [pubmed]
PHST- 2007/03/21 09:00 [medline]
PHST- 2006/12/13 09:00 [entrez]
AID - 10.1097/QAI.0b013e31802e2975 [doi]
PST - ppublish
SO  - J Acquir Immune Defic Syndr. 2007 Feb 1;44(2):229-34. doi: 
      10.1097/QAI.0b013e31802e2975.