Therapeutic Response of HIV-1 Subtype C in African Patients Coinfected with either Mycobacterium tuberculosis or Human Herpesvirus 8

A potential confounding factor in the treatment of HIV infection in Africa is the frequent occurrence of opportunistic infections (OIs). OI-induced immune activation can interfere with HIV-1 clearance by increasing viral replication and target cell availability.

Treatment outcomes for patients dually infected with HIV-1 and Mycobacterium tuberculosis or HIV-1 and human herpesvirus (HHV)-8 were assessed by measuring changes in viral load and CD4+ cell counts and by determining the time taken to reach undetectable HIV-1 RNA levels, assessed by means of Kaplan-Meier survival analysis.

Patients with HIV-1 and Kaposi sarcoma (KS) received generic nevirapine (Viramune), stavudine (Zerit), and lamivudine/3TC (Epivir); patients with HIV-1 and tuberculosis (TB) received standard commercial didanosine (Videx), 3TC, and efavirenz (Sustiva).

Both cohorts exhibited a rapid, near-exponential phase I decline in viral load. Patients with TB and late-stage KS had the steepest decay kinetics. These same patients had the greatest initial increase in CD4+ cell counts. Phase II clearance was slower and more variable.

The proportions of patients reaching undetectable plasma HIV-1 levels at days 7, 14, 28, 60, and 90 were, respectively, 15.8%, 30.0%, 52.6%, 78.9%, and 93.8% (Pearson's χ2 = 50.5; P < .001) for patients with TB and 0.0%, 5.0%, 22.2%, 64.7%, and 80.0% (Pearson's χ2 = 63.6; P < .001) for patients with KS.

Conclusions

The authors conclude, “Nucleoside reverse-transcriptase inhibitor/non nucleoside reverse-transcriptase inhibitor–based treatment regimens are highly effective in clearing rapidly replicating (phase I) virus in African patients dually infected with HIV-1 and either TB or KS.

(See the editorial commentary by  T P Flanigan and others.).

01/03/04

Reference
E Cassol and others. Therapeutic Response of HIV-1 Subtype C in African Patients Coinfected with either Mycobacterium tuberculosis or Human Herpesvirus-8. Journal of Infectious Diseases. December 22, 2004 (online Edition). Scheduled for publication in JID February 1, 2005.