AIDS antiretroviral therapy does not reduce the incidence of tuberculosis in the early months

ARVs do not provide protection against tuberculosis in HIV-infected patients during the first six months, according to a study published in Clinical Infectious Diseases.

According to several studies, highly active antiretroviral therapy (HAART) has reduced the incidence of tuberculosis among HIV-positive 70% to 90%. The disease, however, remains responsible for about 10% of deaths among HIV + adults.

Dr. Enrico Girardi, the National Institute of Infectious Diseases, Rome, and colleagues conducted an international study with data from 12 international cohorts (including two French, the Aquitaine cohort and the French base hospital infection data HIV) to better assess the impact of HAART on TB.

Among the 17 142 naive patients, researchers found an incidence of 13.1 cases per 1,000 person-years during the first six months of treatment, according to the authors' close to that observed in infected untreated figure. " The impact then dropped to 3.05 per 1,000 person-years during the 30 consecutive months.

Over the period (three years after initiation of treatment), the overall incidence was 4.69 cases per 1,000 person-years, while higher among women (5.8 per 1000 person-years ) than men (4.3 cases per 1000 person-years).

According to the authors, these findings confirm other studies showing that "the risk of developing an opportunistic infection is reduced only slightly so in the early months following the initiation of HAART."

In addition, their work has shown that the risk of developing tuberculosis has seriously increased since the 1990s, despite the introduction of HAART. The incidence in HIV patients has increased by 96% between the period prior to 1997 and later in 2001. HAART appeared in 1995.

"This could be due to the change in population affected by HIV," the authors suggested, noting that "the proportion of people migrating from areas of high prevalence of tuberculosis to many European countries has increased."