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The Effect of Tuberculosis Treatment on Virologic and Immunologic Response to Combination Antiretroviral Therapy Among South African Children

Soeters, Heidi M. PhD, MPH*; Sawry, Shobna MSc; Moultrie, Harry MBChB, MSc; Rie, Annelies Van MD, PhD*

JAIDS Journal of Acquired Immune Deficiency Syndromes: 1 October 2014 - Volume 67 - Issue 2 - p 136–144
doi: 10.1097/QAI.0000000000000284
Clinical Science

Background: Many HIV-infected children are diagnosed with tuberculosis (TB), but the effect of TB treatment on virologic and immunologic response to combination antiretroviral therapy (cART) is not well documented.

Methods: Secondary analysis of a prospective cohort of cART-naive HIV-infected South African children aged 0–8 years initiating cART to assess the effect of TB treatment at the time of cART initiation on virologic suppression (HIV RNA < 50 copies/mL), virologic rebound (HIV RNA > 1000 copies/mL after suppression), and CD4 cell percent (CD4%) increase during the first 24 months of cART.

Results: Of 199 children (median age 2.1 years), 92 (46%) were receiving TB treatment at cART initiation. Children receiving and not receiving TB treatment at cART initiation had similar median baseline HIV RNA (5.4 vs. 5.6 copies/mL), median time to virologic suppression (6.2 months in each group, adjusted hazard ratio, 1.36, 95% confidence interval: 0.94 to 1.96), and rates of virologic rebound by 24 months (23% vs. 24%, adjusted hazard ratio 1.53, 95% confidence interval: 0.71 to 3.30). Children on TB treatment had significantly lower median CD4% at baseline (15.3% vs. 18.8%, P < 0.01) and during the first 12 months of cART but experienced similar median increases in CD4% at 6 months (9.9% vs. 9.6%), 12 months (14.2% vs. 11.9%), and 24 months of cART (14.5% vs. 14.2%). Exploratory analyses suggest that children receiving lopinavir/ritonavir-based cART and TB treatment may have inferior virologic and immunologic response compared with children receiving efavirenz-based cART.

Conclusions: Receiving TB treatment at the time of cART initiation did not substantially affect virologic or immunologic response to cART in young children.

*Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC; and

Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of The Witwatersrand, Johannesburg, South Africa.

Correspondence to: Heidi M. Soeters, PhD, MPH, Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 2101 McGavran-Greenberg Hall, CB 7435, Chapel Hill, NC 27599-7435 (e-mail:

Supported by the National Institute of Child Health and Human Development, National Institutes of Health (grant number R01HD058972). The use of REDCap was partially funded by the Clinical and Translational Science Award program of the Division of Research Resources, National Institutes of Health (grant number 1UL1TR001111-01). The United States Agency for International Development's United States President's Emergency Plan for AIDS Relief Project at Wits Reproductive Health Institute provided partial funding for staff, equipment, and technical support at the Harriet Shezi Children's Clinic.

The authors have no conflicts of interest to disclose.

Presented in part at the 44th World Conference on Lung Health, October 30 to November 3, 2013, Paris, France (abstract OP-188-02).

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Received December 09, 2013

Accepted May 23, 2014

© 2014 by Lippincott Williams & Wilkins