No abstract

Introduction In people living with HIV (PWH) with advanced disease, rates of virologic success may be lower than expected. The Reflate TB2 trial did not show non-inferiority of raltegravir versus efavirenz in PWH with tuberculosis. We aimed to identify factors associated with virologic success and higher adherence in the trial. Methods In this analysis, we included participants enrolled in the Reflate TB 2 trial with adherence data available. The primary outcome was virologic success (HIV-1 RNA < 50 copies/mL) at week 48 and the secondary outcome was adherence as assessed by the pill count adherence ratio. We used logistic regression to study determinants of virologic success and optimal adherence in 2 separate analyses. Results 444 participants were included in the present analysis. Over the 48-week follow-up period, 290/444 (65%) participants had a pill count adherence ratio ≥95%. At week 48, 288/444 (65%) participants were in virologic success. In the multivariate analysis, female sex (aOR 1·77 (95%CI 1·16 - 2·72), p = 0·0084), lower baseline HIV-1 RNA levels (<100,000, aOR 2·29 (95%CI 1·33 - 3·96), p = 0·0087) and pill count adherence ratio ≥95% (aOR 2·38 (95%CI 1·56 - 3·62), p < 0·0001), were independently associated with virologic success. Antiretroviral pill burden was the only factor associated with pill count adherence ratio ≥95% (OR 0·81 (95% CI 0·71-0·92), p = 0·0018). Conclusions In PWH with tuberculosis receiving raltegravir or efavirenz-based regimens, female sex, optimal adherence and baseline HIV-1 RNA <100,000 copies/mL were associated with virologic success and the number of antiretroviral tablets taken daily was a strong predictor of adherence.

BU is endemic in tropical and sub-tropical regions mainly with high prevalence in sub-Saharan Africa, in particular in West Africa. SubSaharan Africa is also burdened with high HIV prevalence. Therefore, there is a significant potential for BU and HIV to occur in the same individual, and it represented a treatment challenge related to paradoxical reactions or IRIS onset. A study conducted in Cameroon reported that the mortality rate was higher among HIV-positive/BU patients compared to HIV-negative /BU patients (11% dying compared to 1%). We conducted this work based on review articles on HIV/BU co-infection to summarize information and guidance data to help health care practitioners for proper patients' management. It is becoming obvious that HIV infection have an effect on BU incidence mainly in Sub-Saharan Africa and its clinical presentation and treatment similar to tuberculosis. Based on TB/HIV and HIV/others microorganism s management experience and WHO expert in HIV and BU management guidance protocol, it is recommended to health practitioner. To actively screen all HIV/MU co-infected patients for tuberculosis, before commencing BU treatment and before starting ART. To start BU treatment before commencing ART and it should be provided for 8 weeks duration. The outcomes of HIV/BU coinfection management should be monitored and evaluated, taking account the drugs interactions between ART and antimicrobial agents. And the program for HIV, BU and TB control should work in a collaborative framework. As, HIV/BU co-infection becomes frequent in Sub-Saharan Africa where both disease incidence is high. This represents a treatment challenge related to IRIS occurrence, optimal ART regimens, and when to start ART and antimicrobial treatment. Base on TB/HIV co-infection, the preliminary guidance protocol issue by WHO should be recommended, and further study should be initiated to show its efficacy and to give answers to unknown mechanism of IRIS in HIV/BU co-infection.