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Open Access Timing of antiretroviral therapy and TB treatment outcomes in patients with TB-HIV in Myanmar

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Setting: Integrated HIV Care programme, Mandalay, Myanmar.

Objectives: To determine time to starting antiretroviral treatment (ART) in relation to anti-tuberculosis treatment (ATT) and its association with TB treatment outcomes in patients co-infected with tuberculosis (TB) and the human immunodeficiency virus (HIV) enrolled from 2011 to 2014.

Design: Retrospective cohort study.

Results: Of 1708 TB-HIV patients, 1565 (92%) started ATT first and 143 (8%) started ART first. Treatment outcomes were missing for 226 patients and were thus not included. In those starting ATT first, the median time to starting ART was 8.6 weeks. ART was initiated after 8 weeks in 830 (53%) patients. Unsuccessful outcome was found in 7%, with anaemia being an independent predictor. In patients starting ART first, the median time to starting ATT was 21.6 weeks. ATT was initiated within 3 months in 56 (39%) patients. Unsuccessful outcome was found in 12%, and in 20% of those starting ATT within 3 months. Patients with CD4 count <100/mm3 had a four times higher risk of an unsuccessful outcome.

Conclusions: Timing of ART in relation to ATT was not an independent risk factor for unsuccessful outcome. Extensive screening for TB with rapid and sensitive diagnostic tests in HIV-infected persons and close monitoring of anaemia and immunosuppression are recommended to further improve TB treatment outcomes among patients with TB-HIV.

Keywords: HIV-associated TB; SORT IT; adverse TB treatment outcomes; early ART initiation; operational research; treatment outcome

Document Type: Research Article

Affiliations: 1: International Union Against Tuberculosis and Lung Disease (The Union), Mandalay, Myanmar 2: The Union, South-East Asia Office, New Delhi, India 3: National Tuberculosis Programme, Ministry of Health, Nay Pyi Taw, Myanmar 4: National AIDS Programme (NAP), Ministry of Health, Nay Pyi Taw, Myanmar 5: NAP, Ministry of Health, Mandalay, Myanmar 6: The Union, Paris, France, London School of Hygiene & Tropical Medicine, London, UK

Publication date: 21 June 2016

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  • Public Health Action (PHA), The Union's quarterly Open Access journal, welcomes the submission of articles on operational research. It publishes high-quality scientific research on health services, providing new knowledge on how to improve access, equity, quality and efficiency of health systems and services.

    The Editors will consider any manuscript reporting original research on quality improvements, cost-benefit analysis, legislation, training and capacity building, with a focus on all relevant areas of public health (e.g. infection control, nutrition, TB, HIV, vaccines, smoking, COVID-19, microbial resistance, outbreaks etc).

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