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

mmunology and infectious diseases at Harvard School of Public Health and is co-founder of the Cambodian Health Committee. "This is a tragedy, because TB is completely curable when diagnosed and treated properly even in a patient with advanced HIV, especially if the patient also receives anti-retroviral therapy."

The WHO, in its most recent guidelines, recommended that co-infected patients start ART as soon as possible within eight weeks of initiating anti-TB treatment, but at the time lacked any evidence-based research to provide more fine-grained guidance.

Upon enrollment in the CAMELIA trial, all participants started standard treatment for TB, followed either two weeks or two months later by ART. Patients, all of whom had very weak immune systems, were seen at one of five study sites across Cambodia and followed for as long as four and a half years. By the time enrollment closed, 661 patients had been recruited into the study.

The study's results make a very strong case for starting ART treatment as early as two weeks after initiating treatment for TB. At the end of the study, the survival rate in the early ART arm was 33 percent greater than that in the late ART arm.

The study was also remarkable for its successful level of follow up: Of the trial's 661 participants, only 12 were lost to follow-up over the study period, and participants only missed less than one percent of the study's 8,955 scheduled visits.

"When we started, there was no research infrastructure for conducting such a trial in Cambodia. ART was just being introduced into the country, and HIV and TB were not being treated in an integrated fashion," Goldfeld said. "As side benefits, over the course of the study we helped to establish a center of excellence for HIV and TB care, and a center for treating children with HIV. We also created a national framework in Cambodia for treating patients with multi-drug resistant TB, which is now being replicated in
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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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