Forum for Science, Industry and Business

Sponsored by:     3M 
Search our Site:

 

Early HIV treatment dramatically increases survival in patients co-infected with tuberculosis

20.10.2011
Cambodian study demonstrates that starting antiretroviral treatment two weeks, not two months, after TB treatment increases survival 33 percent

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 immunology 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 Ethiopia.

"We also want to understand how the immune system is restored when you give HIV drugs while treating TB at the same time," Goldfeld continued. "This trial has created an unprecedented opportunity to gain fundamental insights into the workings of the immune system in the context of HIV and TB. It has many fruits yet to bear."

The study, which was previously reported at the 18th Annual AIDS Meeting in Viennea in 2010, was supported by the National Institute of Allergy and Infectious Diseases and the French National Agency for Research on AIDS and Viral Hepatitis.

Children's Hospital Boston is home to the world's largest research enterprise based at a pediatric medical center, where its discoveries have benefited both children and adults since 1869. More than 1,100 scientists, including nine members of the National Academy of Sciences, 11 members of the Institute of Medicine and nine members of the Howard Hughes Medical Institute comprise Children's research community. Founded as a 20-bed hospital for children, Children's Hospital Boston today is a 396 bed comprehensive center for pediatric and adolescent health care grounded in the values of excellence in patient care and sensitivity to the complex needs and diversity of children and families. Children's also is the primary pediatric teaching affiliate of Harvard Medical School. For more information about research and clinical innovation at Children's, visit: http://vectorblog.org.

About the Cambodian Health Committee (CHC, www.cambodianhealthcommittee.org) / Global Health Committee (GHC, www.globalhealthcommittee.org):

Founded in Cambodia in 1994, with a base in Boston, CHC has treated and cured thousands of Cambodians of tuberculosis and provides HIV/AIDS care for thousands more. Its mission is to focus on adults and children who are suffering from tuberculosis (TB) and AIDS, who are among the poorest in our global society. Now also known as the Global Health Committee, it is bringing its unique delivery models of care for TB and AIDS, including access to care for multidrug resistant (MDR) TB, to Ethiopia. CHC/GHC operates from the core belief that good practice depends upon knowledge developed through grassroots experience and rigorous research. With its strategy of delivery of care, discovery of new knowledge, and advocacy, CHC/GHC is developing global models of care while curing TB and treating AIDS one person at a time.

Erin Tornatore | EurekAlert!
Further information:
http://www.childrenshospital.org/

More articles from Health and Medicine:

nachricht Protection for pacemakers
21.11.2019 | ETH Zurich

nachricht Rapid emergence of antibiotic resistance during standard therapy
21.11.2019 | Christian-Albrechts-Universität zu Kiel

All articles from Health and Medicine >>>

The most recent press releases about innovation >>>

Die letzten 5 Focus-News des innovations-reports im Überblick:

Im Focus: Machine learning microscope adapts lighting to improve diagnosis

Prototype microscope teaches itself the best illumination settings for diagnosing malaria

Engineers at Duke University have developed a microscope that adapts its lighting angles, colors and patterns while teaching itself the optimal...

Im Focus: Small particles, big effects: How graphene nanoparticles improve the resolution of microscopes

Conventional light microscopes cannot distinguish structures when they are separated by a distance smaller than, roughly, the wavelength of light. Superresolution microscopy, developed since the 1980s, lifts this limitation, using fluorescent moieties. Scientists at the Max Planck Institute for Polymer Research have now discovered that graphene nano-molecules can be used to improve this microscopy technique. These graphene nano-molecules offer a number of substantial advantages over the materials previously used, making superresolution microscopy even more versatile.

Microscopy is an important investigation method, in physics, biology, medicine, and many other sciences. However, it has one disadvantage: its resolution is...

Im Focus: Atoms don't like jumping rope

Nanooptical traps are a promising building block for quantum technologies. Austrian and German scientists have now removed an important obstacle to their practical use. They were able to show that a special form of mechanical vibration heats trapped particles in a very short time and knocks them out of the trap.

By controlling individual atoms, quantum properties can be investigated and made usable for technological applications. For about ten years, physicists have...

Im Focus: Images from NJIT's big bear solar observatory peel away layers of a stellar mystery

An international team of scientists, including three researchers from New Jersey Institute of Technology (NJIT), has shed new light on one of the central mysteries of solar physics: how energy from the Sun is transferred to the star's upper atmosphere, heating it to 1 million degrees Fahrenheit and higher in some regions, temperatures that are vastly hotter than the Sun's surface.

With new images from NJIT's Big Bear Solar Observatory (BBSO), the researchers have revealed in groundbreaking, granular detail what appears to be a likely...

Im Focus: New opportunities in additive manufacturing presented

Fraunhofer IFAM Dresden demonstrates manufacturing of copper components

The Fraunhofer Institute for Manufacturing Technology and Advanced Materials IFAM in Dresden has succeeded in using Selective Electron Beam Melting (SEBM) to...

All Focus news of the innovation-report >>>

Anzeige

Anzeige

VideoLinks
Industry & Economy
Event News

First International Conference on Agrophotovoltaics in August 2020

15.11.2019 | Event News

Laser Symposium on Electromobility in Aachen: trends for the mobility revolution

15.11.2019 | Event News

High entropy alloys for hot turbines and tireless metal-forming presses

05.11.2019 | Event News

 
Latest News

Scientists first to develop rapid cell division in marine sponges

21.11.2019 | Life Sciences

First detection of gamma-ray burst afterglow in very-high-energy gamma light

21.11.2019 | Physics and Astronomy

Research team discovers three supermassive black holes at the core of one galaxy

21.11.2019 | Physics and Astronomy

VideoLinks
Science & Research
Overview of more VideoLinks >>>