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Early HIV treatment dramatically increases survival in patients co-infected with tuberculosis
Date:10/19/2011

Boston, Mass. Timing is everything when treating patients with both HIV and tuberculosis. Starting HIV therapy in such patients within two weeks of TB treatment, rather than two months as is the current practice, increases survival by 33 percent, according to a large-scale clinical trial in Cambodia led by researchers at Children's Hospital Boston and the Immune Disease Institute (IDI).

The study's results reported by Anne Goldfeld, MD, of the IDI and the Program in Cellular and Molecular Medicine at Children's Hospital Boston, and the CAMELIA (Cambodian Early versus Late Introduction of Antiretrovirals) study team in the October 20 issue of the New England Journal of Medicine definitively show that immunosuppressed HIV-TB co-infected patients should be started on ART rapidly at two weeks after beginning TB therapy. At the same time, the results strongly suggest that the World Health Organization (WHO) should be more aggressive in its recommendations for treating such patients.

A collaboration of Cambodian, French, and American physicians and researchers, the CAMELIA trial set out to settle a long-standing debate in the medical community over the relative timing of antiretroviral (ART) and anti-TB treatment regimens in co-infected patients. Some have advocated for delaying ART for upwards of two months after initiating anti-TB treatment, arguing that the toxicity of and difficulties in adhering to the two regimens (which together require patients to take seven pills every day), as well as the risk of severe inflammation as the immune system rebounds from HIV's suppressive influence, create undue burden on patients. Those supporting early initiation of ART note that rapid restoration of immune function bolsters the effects of anti-TB treatment.

"Tuberculosis claims the lives of more than half a million people with HIV worldwide every year," said Goldfeld, who holds professorships in medicine at Harvard Medical School and i
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Contact: Erin Tornatore
erin.tornatore@childrens.harvard.edu
617-919-3110
Children's Hospital Boston
Source:Eurekalert

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