دورية أكاديمية
A Trial of Early Antiretrovirals and Isoniazid Preventive Therapy in Africa
| العنوان: | A Trial of Early Antiretrovirals and Isoniazid Preventive Therapy in Africa |
|---|---|
| المؤلفون: | TEMPRANO ANRS 12136 Study Group, Danel, C, Moh, R, Gabillard, D, Badje, A, Le Carrou, J, Ouassa, T, Ouattara, E, Anzian, A, Ntakpé, JB, Minga, A, Kouame, GM, Bouhoussou, F, Emieme, A, Kouamé, A, Inwoley, A, Toni, TD, Ahiboh, H, Kabran, M, Rabe, C, Sidibé, B, Nzunetu, G, Konan, R, Gnokoro, J, Gouesse, P, Messou, E, Dohoun, L, Kamagate, S, Yao, A, Amon, S, Kouame, AB, Koua, A, Kouamé, E, Ndri, Y, Ba-Gomis, O, Daligou, M, Ackoundzé, S, Hawerlander, D, Ani, A, Dembélé, F, Koné, F, Guéhi, C, Kanga, C, Koule, S, Séri, J, Oyebi, M, Mbakop, N, Makaila, O, Babatunde, C, Babatounde, N, Bleoué, G, Tchoutedjem, M, Kouadio, AC, Sena, G, Yededji, SY, Assi, R, Bakayoko, A, Mahassadi, A, Attia, A, Oussou, A, Mobio, M, Bamba, D, Koman, M, Horo, A, Deschamps, N, Chenal, H, Sassan-Morokro, M, Konate, S, Aka, K, Aoussi, E, Journot, V, Nchot, C, Karcher, S, Chaix, ML, Rouzioux, C, Sow, PS, Perronne, C, Girard, PM, Menan, H, Bissagnene, E, Kadio, A, Ettiegne-Traore, V, Moh-Semdé, C, Kouame, A, Massumbuko, JM, Chêne, G, Dosso, M, Domoua, SK, N'Dri-Yoman, T, Salamon, R, Eholié, SP, Anglaret, X |
| المصدر: | 822 ; 808 |
| بيانات النشر: | Massachusetts Medical Society |
| سنة النشر: | 2015 |
| المجموعة: | Imperial College London: Spiral |
| مصطلحات موضوعية: | AIDS-Related Opportunistic Infections, Adult, Anti-Retroviral Agents, Antitubercular Agents, Asymptomatic Diseases, CD4 Lymphocyte Count, Cote d'Ivoire, Female, Follow-Up Studies, HIV Infections, HIV-1, Humans, Isoniazid, Male, Middle Aged, RNA, Viral, Time-to-Treatment, Tuberculosis, Viral Load, TEMPRANO ANRS 12136 Study Group, General & Internal Medicine, 11 Medical And Health Sciences |
| الوصف: | BACKGROUND: In sub-Saharan Africa, the burden of human immunodeficiency virus (HIV)-associated tuberculosis is high. We conducted a trial with a 2-by-2 factorial design to assess the benefits of early antiretroviral therapy (ART), 6-month isoniazid preventive therapy (IPT), or both among HIV-infected adults with high CD4+ cell counts in Ivory Coast. METHODS: We included participants who had HIV type 1 infection and a CD4+ count of less than 800 cells per cubic millimeter and who met no criteria for starting ART according to World Health Organization (WHO) guidelines. Participants were randomly assigned to one of four treatment groups: deferred ART (ART initiation according to WHO criteria), deferred ART plus IPT, early ART (immediate ART initiation), or early ART plus IPT. The primary end point was a composite of diseases included in the case definition of the acquired immunodeficiency syndrome (AIDS), non-AIDS-defining cancer, non-AIDS-defining invasive bacterial disease, or death from any cause at 30 months. We used Cox proportional models to compare outcomes between the deferred-ART and early-ART strategies and between the IPT and no-IPT strategies. RESULTS: A total of 2056 patients (41% with a baseline CD4+ count of ≥500 cells per cubic millimeter) were followed for 4757 patient-years. A total of 204 primary end-point events were observed (3.8 events per 100 person-years; 95% confidence interval [CI], 3.3 to 4.4), including 68 in patients with a baseline CD4+ count of at least 500 cells per cubic millimeter (3.2 events per 100 person-years; 95% CI, 2.4 to 4.0). Tuberculosis and invasive bacterial diseases accounted for 42% and 27% of primary end-point events, respectively. The risk of death or severe HIV-related illness was lower with early ART than with deferred ART (adjusted hazard ratio, 0.56; 95% CI, 0.41 to 0.76; adjusted hazard ratio among patients with a baseline CD4+ count of ≥500 cells per cubic millimeter, 0.56; 95% CI, 0.33 to 0.94) and lower with IPT than with no IPT (adjusted hazard ratio, 0.65; ... |
| نوع الوثيقة: | article in journal/newspaper |
| اللغة: | unknown |
| تدمد: | 1533-4406 |
| العلاقة: | New England Journal of Medicine; http://hdl.handle.net/10044/1/41218Test; http://dx.doi.org/10.1056/NEJMoa1507198Test |
| DOI: | 10.1056/NEJMoa1507198 |
| الإتاحة: | https://doi.org/10.1056/NEJMoa1507198Test http://hdl.handle.net/10044/1/41218Test |
| حقوق: | From N Engl J Med 2015; 373:808-822 © 2015 Massachusetts Medical Society. Reprinted with permission. |
| رقم الانضمام: | edsbas.40E8EACE |
| قاعدة البيانات: | BASE |
| تدمد: | 15334406 |
|---|---|
| DOI: | 10.1056/NEJMoa1507198 |