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Antiretroviral Therapy Reduces Tuberculosis Incidence in Areas Where AIDS, TB Endemic, Study Shows
Highly active antiretroviral therapy can reduce the incidence of
tuberculosis in HIV-positive people by 80% or more in areas where the two diseases are endemic, with the most protection being afforded to those with advanced immune suppression, according to a study published in the June 15 issue of the Lancet. Motasim Badri of the HIV Clinical Research Unit at the University of Cape Town, South Africa, and colleagues compared the risk of TB development in 264 South African HIV-positive patients who received HAART as part of a Phase III clinical trial with the risk in 770 HIV-positive patients who did not receive the combination drug treatment at the university's Somerset Hospital between 1992 and 2001. HAART was associated with a lower incidence of TB -- 2.4 cases per 100 patient-years compared to 9.7 cases per 100 patient-years
-- regardless of socioeconomic status, baseline WHO disease stage and CD4+ T cell count, except in patients with CD4+ T cell counts of more than 350 cells per microliter. The number of TB cases averted was greatest in patients with CD4+ T cell counts less than 200 cells per microliter and in patients with a WHO stage 3 or 4 diagnosis. The authors conclude that HAART can play a "critical role in addressing the therapeutic nihilism surrounding HIV-1 and tuberculosis co-epidemic" in areas like South Africa, where the two diseases are endemic (Badri et al., Lancet, 6/15).
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