Prolonged deferral of antiretroviral therapy in the SAPIT trial: Did we need a clinical trial to tell us that this would increase mortality?

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dc.contributor.authorBoulle, Andrew
dc.contributor.authorClayden, Polly
dc.contributor.authorCohen, Karen
dc.contributor.authorCohen, Ted
dc.contributor.authorConradie, Francesca
dc.contributor.authorDong, Christa
dc.contributor.authorGeffen, Nathan
dc.contributor.authorGrimwood, Ashraf
dc.contributor.authorHurtado, Rocio
dc.contributor.authorKenyon, Christopher
dc.contributor.authorLawn, Stephen
dc.contributor.authorMaartens, Gary
dc.contributor.authorMeintjes, Graeme
dc.contributor.authorMendelson, Marc
dc.contributor.authorMurray, Megan
dc.contributor.authorRangaka, Molebogeng
dc.contributor.authorSanne, Ian
dc.contributor.authorSpencer, David
dc.contributor.authorTaljaard, Jantjie
dc.contributor.authorVariava, Ebrahim
dc.contributor.authorVenter, W D Francois
dc.contributor.authorWilson, Douglas
dc.date.accessioned2021-10-08T07:17:57Z
dc.date.available2021-10-08T07:17:57Z
dc.date.issued2010
dc.description.abstractTuberculosis is the major cause of morbidity and mortality in HIVinfected patients in sub-Saharan Africa. HIV infection is often first diagnosed following a diagnosis of tuberculosis, with many patients needing antiretroviral therapy (ART). Starting ART in HIV-infected patients with tuberculosis (TB) may be associated with complications, including side-effects from co-administration of multiple drugs with many overlapping toxicities, reductions in concentrations of certain antiretroviral drugs following the induction of metabolising enzymes and drug transporters by rifampicin, and paradoxical deterioration due to the immune reconstitution inflammatory syndrome (IRIS). Furthermore, the high pill burden of co-treatment could reduce adherence, resulting in poor treatment outcomes for both diseases. These potential harms must be weighed against the high mortality rates in patients with HIV-associated tuberculosis who do not receive ART, especially those with low CD4 counts. The optimal time to initiate ART in patients with tuberculosis is an important research question, and randomised controlled trials are addressing this issue.
dc.identifier.apacitationBoulle, A., Clayden, P., Cohen, K., Cohen, T., Conradie, F., Dong, C., ... Wilson, D. (2010). Prolonged deferral of antiretroviral therapy in the SAPIT trial: Did we need a clinical trial to tell us that this would increase mortality?. <i>South African Medical Journal</i>, 100(9), 566 - 177. http://hdl.handle.net/11427/34871en_ZA
dc.identifier.chicagocitationBoulle, Andrew, Polly Clayden, Karen Cohen, Ted Cohen, Francesca Conradie, Christa Dong, Nathan Geffen, et al "Prolonged deferral of antiretroviral therapy in the SAPIT trial: Did we need a clinical trial to tell us that this would increase mortality?." <i>South African Medical Journal</i> 100, 9. (2010): 566 - 177. http://hdl.handle.net/11427/34871en_ZA
dc.identifier.citationBoulle, A., Clayden, P., Cohen, K., Cohen, T., Conradie, F., Dong, C., Geffen, N. & Grimwood, A. et al. 2010. Prolonged deferral of antiretroviral therapy in the SAPIT trial: Did we need a clinical trial to tell us that this would increase mortality?. <i>South African Medical Journal.</i> 100(9):566 - 177. http://hdl.handle.net/11427/34871en_ZA
dc.identifier.issn0038-2469
dc.identifier.ris TY - Journal Article AU - Boulle, Andrew AU - Clayden, Polly AU - Cohen, Karen AU - Cohen, Ted AU - Conradie, Francesca AU - Dong, Christa AU - Geffen, Nathan AU - Grimwood, Ashraf AU - Hurtado, Rocio AU - Kenyon, Christopher AU - Lawn, Stephen AU - Maartens, Gary AU - Meintjes, Graeme AU - Mendelson, Marc AU - Murray, Megan AU - Rangaka, Molebogeng AU - Sanne, Ian AU - Spencer, David AU - Taljaard, Jantjie AU - Variava, Ebrahim AU - Venter, W D Francois AU - Wilson, Douglas AB - Tuberculosis is the major cause of morbidity and mortality in HIVinfected patients in sub-Saharan Africa. HIV infection is often first diagnosed following a diagnosis of tuberculosis, with many patients needing antiretroviral therapy (ART). Starting ART in HIV-infected patients with tuberculosis (TB) may be associated with complications, including side-effects from co-administration of multiple drugs with many overlapping toxicities, reductions in concentrations of certain antiretroviral drugs following the induction of metabolising enzymes and drug transporters by rifampicin, and paradoxical deterioration due to the immune reconstitution inflammatory syndrome (IRIS). Furthermore, the high pill burden of co-treatment could reduce adherence, resulting in poor treatment outcomes for both diseases. These potential harms must be weighed against the high mortality rates in patients with HIV-associated tuberculosis who do not receive ART, especially those with low CD4 counts. The optimal time to initiate ART in patients with tuberculosis is an important research question, and randomised controlled trials are addressing this issue. DA - 2010 DB - OpenUCT DP - University of Cape Town IS - 9 J1 - South African Medical Journal LK - https://open.uct.ac.za PY - 2010 SM - 0038-2469 T1 - Prolonged deferral of antiretroviral therapy in the SAPIT trial: Did we need a clinical trial to tell us that this would increase mortality? TI - Prolonged deferral of antiretroviral therapy in the SAPIT trial: Did we need a clinical trial to tell us that this would increase mortality? UR - http://hdl.handle.net/11427/34871 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/34871
dc.identifier.vancouvercitationBoulle A, Clayden P, Cohen K, Cohen T, Conradie F, Dong C, et al. Prolonged deferral of antiretroviral therapy in the SAPIT trial: Did we need a clinical trial to tell us that this would increase mortality?. South African Medical Journal. 2010;100(9):566 - 177. http://hdl.handle.net/11427/34871.en_ZA
dc.language.isoeng
dc.publisher.departmentDepartment of Public Health and Family Medicine
dc.publisher.facultyFaculty of Health Sciences
dc.sourceSouth African Medical Journal
dc.source.journalissue9
dc.source.journalvolume100
dc.source.pagination566 - 177
dc.source.urihttps://dx.doi.org/10.7196/SAMJ.4434
dc.subject.otherAIDS-Related Opportunistic Infections
dc.subject.otherAnti-Bacterial Agents
dc.subject.otherAnti-Retroviral Agents
dc.subject.otherCD4 Lymphocyte Count
dc.subject.otherClinical Trials as Topic
dc.subject.otherDrug Administration Schedule
dc.subject.otherHIV Infections
dc.subject.otherHumans
dc.subject.otherImmune Reconstitution Inflammatory Syndrome
dc.subject.otherSouth Africa
dc.subject.otherTherapeutic Equipoise
dc.subject.otherTuberculosis
dc.subject.otherAnti-Bacterial Agents
dc.titleProlonged deferral of antiretroviral therapy in the SAPIT trial: Did we need a clinical trial to tell us that this would increase mortality?
dc.typeJournal Article
uct.type.publicationResearch
uct.type.resourceJournal Article
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