Greater access to HIV and tuberculosis medications is needed worldwide
A Penn-led study finds a specific combination of HIV and TB treatments, which is difficult to obtain in certain parts of the world, decreased the mortality risk for patients with HIV and multidrug-resistant TB.
After looking at the health records of over 10,000 patients with both HIV and multidrug resistant Tuberculosis (TB) in over 20 different countries, researchers at the Perelman School of Medicine in collaboration with the Centers for Disease Control and Prevention, McGill University, and other institutions around the world, found that implementing antiretroviral therapy (ART) for HIV and newer tuberculosis medications decreased the risk of death for adults with drug-resistant TB. While the treatments associated with lower mortality risk are common in the United States and are recommended by the WHO as the best treatment for these patients, global accessibility varies widely. The findings, which were published in The Lancet, suggest that every effort should be made to quickly bring these life-saving medications to those in need.
In the largest individual patient data meta-analysis study to assess mortality risk of people with both HIV and multi-drug resistant TB, scientists first compared the risk of death for HIV-positive people versus HIV-negative people, then examined how receiving ART and different types of TB drugs altered this risk. Because of the large sample size, associations of specific TB drugs with mortality were evaluated, focusing on the most effective drugs, categorized as Group A by the World Health Organization (WHO). Data from 52 studies and 37 different countries was used, and the investigators controlled for things like age, the wealth of the region in which the individuals lived, and severity of drug resistance. Researchers ultimately found that while patients with HIV infection were at higher risk of death, this risk was reduced substantially when Group A TB drugs and ART were used. As there are various types of Group A TB medications, the odds survival varied based on which Group A medication or combination was employed. When looking at only those with HIV, the risk of death was reduced by over 80% with use of specific TB drugs.
“Previous smaller studies had suggested these associations, but the large scale of this study solidifies the importance of using ART and the WHO Group A TB medications such as later-generation fluoroquinolones, bedaquiline, and linezolid to treat those who both have drug-resistant TB and are also HIV positive,” says lead author Gregory Bisson, an infectious diseases specialist and an associate professor of medicine. “In addition, using mortality as a measure of whether this treatment was effective offered clear answers as to just how valuable these medications are.”
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