Simultaneous HAART improves survival in children coinfected with HIV and TB.

Objectives: This study assesses the outcome of current treatment guidelines and the effect of highly active antiretroviral therapy (HAART) on survival of HIV/TB-coinfected patients in a resource-limited setting.

Methods: Observational cohort study at the pediatric HIV Clinic, RML Hospital, Delhi. All HIV-infected patients who visited the clinic for the diagnosis of TB between 2002 and 2006 were observed until 31 March 2010. TB was diagnosed either at the time of enrolment or during follow-up visits. Clinical and epidemiological data were registered. We compared children who were given HAART with TB treatment at time of diagnosis [simultaneous therapy (ST)] and children who received delayed HAART. Survival was assessed by Kaplan-Meier method and Cox regression model.

Results: Among the 298 children, 126 (42.2%) had TB, including 96 who received ST (76% of 126) and 30 who did not. There were no differences between the two groups except for a lower CD4 count in patients undergoing ST. ST was associated with improved survival [hazard ratio (HR), 0.35; 95% CI, 0.20-0.74; P = 0.002] and so were year of TB diagnosis and other AIDS-defining conditions. Multivariate analysis revealed that ST was a powerful predictor of survival (HR, 0.30; 95% CI, 0.14-0.68; P = 0.003). After adjusting for other prognostic variables such as age, gender, CD4 count at time of TB diagnosis, by Cox multivariate analysis, ST remained robustly associated with improved survival (HR, 0.32; 95% CI, 0.17-0.71; P = 0.001).

Conclusions: Starting HAART during tuberculosis therapy significantly improves survival and provides further impetus for the integration of TB and HIV services.