When to start antiretroviral therapy in children with TB?

Abstract

Evaluation of: Yotebieng M, Van Rie A, Moultrie H et al. Effect on mortality and virological response of delaying antiretroviral therapy initiation in children receiving tuberculosis treatment. AIDS 24, 1341–1349 (2010).

The initiation of antiretroviral therapy (ART) after starting TB treatment is complex, involving many variables including treatment tolerance, drug co-toxicities, pharmacokinetic drug interactions and polypharmacy impacts on adherence. Delayed ART potentially allows better determination of a specific cause for a drug side effect, decreasing the severity of paradoxical reactions and adherence difficulties. However, of overriding importance is mortality associated with delayed ART initiation versus mortality associated with immune restoration disease with early ART. While results of adult randomized trials addressing this question are becoming available, there are little data to inform the ‘when to start’ question for children.

Keywords::

• ART initiation
• children
• HIV
• South Africa
• TB

Financial & competing interests disclosure

Robin Wood has received support from the following NIH grants: CEPAC (5 R01 AI058736-02), USAID Right to Care (CA 674 A 00 08 0000 700) and CIPRA (IU19 AI53217-07). The author has no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.