1. In HIV-1, immediate vs deferred antiretroviral therapy and isoniazid vs no isoniazid reduced severe illness at 30 mo.
- Author
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Smaill, Fiona
- Subjects
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DRUG therapy for tuberculosis , *ISONIAZID , *ANTIRETROVIRAL agents , *AIDS , *FACTORIAL experiment designs , *HIV , *HIV infections , *LONGITUDINAL method , *MEDICAL protocols , *MORTALITY , *AIDS-related opportunistic infections , *RANDOMIZED controlled trials , *HIGHLY active antiretroviral therapy , *TREATMENT effectiveness , *SEVERITY of illness index , *TREATMENT delay (Medicine) , *THERAPEUTICS - Abstract
Questions: In adults with HIV-1 infection, does immediate antiretroviral therapy (ART) reduce severe illness compared with deferred ART? Does isoniazid preventive therapy (IPT) reduce severe illness compared with no IPT? Methods Design: Randomized, controlled, 2 x 2 factorial trial (TEMPRANO ANRS 12136 trial). ClinicalTrials.gov NCT00495651. Allocation: Concealed.* Blinding: Unblinded.* Follow-up period: 30 months. Setting: 9 centers in Abidjan, Ivory Coast. Patients: 2076 patients ≥ 18 years of age (median age 35 y, 79% women, median CD4+ count 459 to 467 cells/mm[sup 3]) who had HIV-1 infection or dual HIV-1 and HIV-2 infection, CD4+ count < 800 cells/mm[sup 3], and did not meet World Health Organization (WHO) criteria for starting ART. Intervention: ART started immediately (n = 1041) or deferred until WHO criteria for starting ART were reached (n = 1035). Patients were also randomized to IPT, 300 mg/d starting 1 month after randomization and continuing for 6 months (n = 1038), or no IPT (n = 1038). Outcomes: Primary outcome was a composite of all-cause mortality or severe HIV-related illness (AIDS-defining disease, non–AIDS-defining cancer, or non–AIDS-defining invasive bacterial disease). Other outcomes included grade 3 or 4 adverse events (severe or life-threatening events including gastrointestinal, respiratory, cardiovascular, cutaneous, neurologic, or other adverse events, or hematologic or biochemical test abnormalities). Patient follow-up: 85% completed the 30-month visit or died (intention-to-treat analysis). Main results: Immediate ART, with or without IPT, reduced the primary outcome compared with deferred ART, with or without IPT (Table). IPT, with early or deferred ART, reduced the primary outcome compared with no IPT, with early or deferred ART (Table). No interaction was found between treatments and the primary outcome. Immediate ART did not differ from deferred ART and IPT did not differ from no IPT for all-cause mortality (Table). Immediate ART increased grade 3 or 4 adverse events at < 6 months (4.2% vs 1.7%, relative risk increase 154%, 95% CI 46 to 338) and reduced events at 6 to 30 months (2.6% vs 5.6%, relative risk reduction 52%, CI 23 to 69) compared with deferred ART; IPT did not differ from no IPT for grade 3 or 4 adverse events at < 6 months or 6 to 30 months. Conclusion: In adults with HIV-1 infection, immediate vs deferred antiretroviral therapy and isoniazid preventive therapy vs no isoniazid reduced severe illness at 30 months. [ABSTRACT FROM AUTHOR]
- Published
- 2015