Christoper John N Tibayan and Emmanuel Surposa
Ospital ng Makati, Philippines
Posters & Accepted Abstracts: J AIDS Clin Res
Research Question: Among patients with HIV-tuberculosis, how effective is late initiation of antiretroviral therapy compared to early initiation of antiretroviral therapy following anti Koch├ó┬?┬?s regimen in decreasing the incidence of paradoxical immune reconstitution inflammatory syndrome (IRIS)? Background: IRIS is defined as a worsening of existing lesions or presentation of new lesions during treatment of an opportunistic infection most frequently seen among patients on anti-Koch├ó┬?┬?s regimen. Randomized controlled trials showed that delaying initiation of antiretroviral treatment for about 4 weeks or more after starting anti-Koch├ó┬?┬?s regimen showed a decreased incidence of IRIS among HIV patients with concomitant tuberculosis. Objective: This meta-analysis aims to compare the effects of late initiation of antiretroviral therapy with early initiation of antiretroviral therapy following anti-Koch├ó┬?┬?s regimen among patients with HIV-tuberculosis co-infection with primary outcome measured as paradoxical TB-IRIS. Materials & Methods: Online databases were used to search for randomized controlled trials published from January 2010 to June 2015. Review Manager 5.3 was used for to compute for the total odds ratios for both interventions using a fixed-effects model with 95% confidence interval. Results: Seven randomized controlled trials were included. Late Initiation of antiretroviral therapy (>4 weeks following initiation of anti-Koch├ó┬?┬?s regimen) among patients with HIV-Tuberculosis is associated with lower odds of developing Paradoxical TBIRIS (OR: 0.54 at 95% confidence interval, p<0.00001). Conclusion: Late initiation of antiretroviral therapy following standard anti-Koch├ó┬?┬?s regimen is associated with lower odds of developing Paradoxical TB-IRIS, however has been associated with increase in overall mortality as compared with mortality associated with paradoxical IRIS. Baseline CD4+ cell counts <50/ul has been identified as an independent risk factor for both mortality and development of Paradoxical TB-IRIS. A larger study population and elimination of probable confounding variables are recommended in future researches.
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