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Long-term efficacy of nevirapine-based anti-retroviral therapy among HIV-1 infected patients with/without previous rifampicin, and treatment outcomes of tuberculosis: a 144-week prospective study

Abstract number: O523

Manosuthi W., Tantanathip P., Prasithisirikul W., Chimsuntorn S., Sungkanuparph S.

Objectives: To evaluate the long-term efficacy of nevirapine (NVP)-based antiretroviral therapy (ART) among HIV-1 infected patients who previously received this regimen with rifampicin (RIF) and to assess the long-term outcomes of tuberculosis (TB) in a resource-limited setting.

Methods: HIV-1/TB co-infected patients receiving RIF (group A) and HIV-1 mono-infection not receiving RIF (group B) were enrolled to receive NVP 400 mg/day with stavudine and lamivudine in a prospective study. Plasma HIV-1 RNA and CD4 cell counts were studied every 12 weeks through 96 weeks and then every 24 weeks until 144 weeks. Re-evaluation of clinical TB and chest X-ray were performed at week 144. Genotypic resistance testing was conducted in patients who had HIV-1 RNA >1,000 copies/mL.

Results: Of 140 patients (70/group), 68% were male and median (IQR) CD4 was 29 cells/mm3. Of 70 patients in group A, 31 (44%), 20 (29%), 14 (20%), 3 (4%), 2 (3%) patients were diagnosed with pulmonary TB, disseminated TB, cervical TB lymphadenitis, gastrointestinal TB and TB meningitis, respectively. By intend-to-treat analysis, 61% (43/70) in group A and 57% (40/70) in group B maintained plasma HIV-1 RNA <50 copies/mL at 144 weeks of ART (P = 0.731, OR=1.194, 95%CI=0.608–2.346). At week 144, median (IQR) CD4 was 367 (260–541) cells/mm3 and 393 (286–501) cells/mm3 in the corresponding groups (P = 0.646). Of 70 patients in each group, 10% (7/70) and 9% (6/70) patients in the corresponding groups developed HIV-1 RNA >1,000 copies/ml (P=1.000). For NRTI-resistance associated mutations, M184V was observed 71% (5/7) in group A and 83% (5/6) in group B (P=1.000). TAMs, K65R, and Q151M were observed 0% (0/7), 29% (2/7), and 0% (0/0) in group A and 17% (1/6), 0% (0/6), and 0% (0/6) in group B, respectively (P > 0.05). For NNRTI-resistance associated mutations, Y181C/I was the most common mutation and found 71% (5/7) in group A and 50% (3/6) in group B (P = 0.592). For 70 outcomes of TB in group A, 55 (79%) were cure/completed treatment; 7 (10%), 5 (7%), 2 (3%) and 1 (1%) were lost to follow-up, died, transferred care and recurrent TB, respectively.

Conclusions: There is no difference of the 144-week efficacy between HIV-1/TB co-infected patients receiving RIF and HIV-1 mono-infection not receiving RIF. Long-term TB outcomes are favourable. In resource-limited settings, NVP 400 mg/day-based ART is an appropriate option for HIV-1 infected patients who receive RIF.

Session Details

Date: 19/04/2008
Time: 00:00-00:00
Session name: 18th European Congress of Clinical Microbiology and Infectious Diseases
Subject:
Location: Barcelona, Spain
Presentation type:
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