Lipid profile changes in Thai HIV and tuberculosis co-infected patients receiving non-nucleoside reverse transcriptase inhibitors-based antiretroviral therapy.

OBJECTIVE: To study and compare the pattern of lipid profile changes in Thai HIV and tuberculosis (TB) co-infected patients after receiving two non-nucleoside reverse transcriptase inhibitors (NNRTIs)-based antiretroviral therapy (ART). MATERIAL AND METHOD: From an open label, randomized, comparative trial comparing treatment outcome between HIV and TB co-infected patients receiving nevirapine (NVP) or efavirenz (EFV) combined with stavudine and lamivudine, patient's body mass index (BMI), CD4 cell count, plasma HIV-1 RNA, fasting blood glucose, plasma total cholesterol (TC), low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C), and triglyceride (TG) were collected at baseline, 24, and 48 weeks of ART. RESULTS: Of the 121 patients included in the present study, mean (SD) age was 36.9 (8.4) years and 66% were male. After 48 weeks of ART the median (IQR) percentage of TC, LDL-C, HDL-C and TG values were 21.1% (5.4-40.7), 23.5% (-0.8-49.8), 22.7% (0-50) and -1.0% (-34.6-32.2) respectively. The median (IQR) percentage change of the HDL-C value was significantly higher in NVP-based than EFV-based ART (31.9 [9.6-50.0] vs. 12.2 [-8.8-51.2]; p = 0.03). The proportions of patients with high TC (21.5%) and high LDL-C (29.2%) increased and low HDL-C (11.6%) decreased significantly at 48 weeks of ART compared to baseline (all, p < 0.01). The proportions of patients with high TC, high TG and low HDL-C were significantly higher in the EFV group than in the NVP group (p = 0.03 for high TC, p = .01 for high TG and p < 0.01 for low HDL-C). CONCLUSION: NNRTI-based ART is associated with increases of TC, LDL-C and HDL-C values in Thai HIV and TB co-infected patients. More favorable lipid profile is observed in NVP-based than EFV-based ART.

Hepatotoxicity in patients co-infected with tuberculosis and HIV-1 while receiving non-nucleoside reverse transcriptase inhibitor-based antiretroviral therapy and rifampicin-containing anti-tuberculosis regimen.

To evaluate the rate of and risk factors for hepatotoxicity in tuberculosis (TB) and human immunodeficiency virus type 1 (HIV-1) co-infected patients while receiving non-nucleoside reverse transcriptase inhibitor (NNRTI)-based antiretroviral therapy (ART) and a rifampicin (RMP)-containing anti-TB regimen. We analyzed data from the N2R study which was an open label, randomized, comparative trial comparing treatment outcomes between 71 TB/HIV-1 co-infected patients receiving efavirenz (EFV)-based and nevirapine (NVP)-based ART; all of whom were receiving RMP-containing anti-TB treatment. Demographic data, liver function test, CD4 cell count, plasma HIV-1 RNA, hepatitis B surface antigen and anti-hepatitis C virus antibody were collected before initiating ART (week 0). Liver enzymes and total bilirubin levels were monitored at 6 weeks, 12 weeks and 24 weeks after ART initiation. All patients were followed until TB therapy was completed. Of 142 patients, 8 patients were excluded. Among the remaining 134 patients, the mean+/-SD age was 36.8+/-8.6 years and 67.2% were male. Severe hepatotoxicity (grade 3 or 4) developed in 4 patients (2.9%); 3 patients (4.6%) in the NVP group and 1 patient (1.4%) in the EFV group. Severe hyperbilirubinemia (grade 3 or 4) occurred in 7 patients (5.2%); 5 patients (7.7%) in the NVP group and 2 patients (2.9%) in the EFV group. Grade 1 or 2 hepatotoxicity occurred in 34 patients (31.4%). Hepatitis C virus co-infection (adjusted OR 3.03; 95%CI 1.26-7.29) was an independent risk factor associated with grade 1-4 hepatotoxicity (p=0.013). Monitoring of hepatotoxicity should be considered in TB/HIV-1 co-infected patients who are infected with HCV and receiving NVP.

Causes of death in HIV-infected persons who have tuberculosis, Thailand.

Up to 50% of persons with HIV and a diagnosis of tuberculosis (TB) in Thailand die during TB treatment. In a prospective observational study, a team of physicians ascribed the cause of death after reviewing verbal autopsies (interviews of family members about events preceding death), laboratory data, and medical records. Of 849 HIV-infected TB patients enrolled, 142 (17%) died. The cause of death was TB for 38 (27%), including 6 with multidrug-resistant TB and 20 with disseminated TB; an HIV-associated condition other than TB for 50 (35%); and a condition unrelated to TB or HIV for 22 (15%). Twenty-three patients (16%) were judged not to have had TB at all. Death from all causes except those unrelated to TB or HIV was less common in persons receiving antiretroviral therapy (ART). In addition to increasing the use of ART, death rates may be reduced through expanded use of modern TB diagnostic techniques.