Simultaneous Versus Sequential Antiretroviral Therapy (ARV) Therapy and Mycobacterium Tuberculosis (MTB) Treatment

NCT ID: NCT00737724

Last Updated: 2015-03-26

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

TERMINATED

Clinical Phase

NA

Total Enrollment

63 participants

Study Classification

INTERVENTIONAL

Study Start Date

2008-03-31

Study Completion Date

2011-02-28

Brief Summary

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The purpose of this study is to evaluate and compare the efficacy of immediate antiretroviral therapy versus 2 month deferred anti-Tb therapy upon the clinical course of tuberculosis and HIV infection in patients with AIDS and active tuberculosis.

Detailed Description

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AIDS and tuberculosis are two international and national priority public health problems. The best time for starting antiretroviral therapy in patients with AIDS and active tuberculosis is not clear, despite of the guidelines regarding CD4+ count. The debate surrounding this issue is mainly due to the difficulty among adherence of anti-MTb and anti-HIV treatment, the pharmacological interaction, the adverse events related to drugs and the risk of inflammatory reconstitution syndrome, especially in patients with advanced HIV infection. Moreover, there is great debate upon the lack of knowledge of the degree of immune reconstitution throughout time against Mtb induced by the anti-HIV therapy.

Conditions

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HIV AIDS Tuberculosis

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Group 1

Receives both, simultaneously antiretroviral therapy and antituberculosis therapy

Group Type EXPERIMENTAL

Simultaneous ARV and antiMTB

Intervention Type DRUG

Receives both, simultaneously antiretroviral therapy and antituberculosis therapy

Group 2

Receives only antituberculosis therapy, and 2 months afterwards antiretroviral therapy

Group Type EXPERIMENTAL

Deferred RV and antiMTB treatment

Intervention Type DRUG

Receives only antituberculosis therapy and 2 months afterwards antiretroviral therapy

Interventions

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Simultaneous ARV and antiMTB

Receives both, simultaneously antiretroviral therapy and antituberculosis therapy

Intervention Type DRUG

Deferred RV and antiMTB treatment

Receives only antituberculosis therapy and 2 months afterwards antiretroviral therapy

Intervention Type DRUG

Other Intervention Names

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HAART isoniazid Efavirenz Truvada HAART isoniazid Efavirenz Truvada

Eligibility Criteria

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Inclusion Criteria

* HIV infected
* \< 200 CD4+ cells/mL
* Active pulmonary tuberculosis (with or without extrapulmonary involvement)

Exclusion Criteria

* Meningeal tuberculosis
* Unable to attend 96 wk follow-up
Minimum Eligible Age

18 Years

Maximum Eligible Age

60 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Consorcio de Investigación sobre VIH/SIDA/TB (CISIDAT).

OTHER

Sponsor Role collaborator

Instituto Nacional de Enfermedades Respiratorias

OTHER_GOV

Sponsor Role lead

Responsible Party

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Gustavo Reyes-Teran

Principal Investigator

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Gustavo Reyes-Terán, MD

Role: PRINCIPAL_INVESTIGATOR

Instituto Nacional de Enfermedades Respiratorias

Locations

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Hospital Civil de Guadalajara Fray Antonio Alcalde

Guadalajara, Jalisco, Mexico

Site Status

Centro de Investigaciones en Enfermedades Infecciosas

Mexico City, Mexico City, Mexico

Site Status

Countries

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Mexico

References

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Raviglione MC, Narain JP, Kochi A. HIV-associated tuberculosis in developing countries: clinical features, diagnosis, and treatment. Bull World Health Organ. 1992;70(4):515-26.

Reference Type BACKGROUND
PMID: 1394786 (View on PubMed)

De Cock KM, Soro B, Coulibaly IM, Lucas SB. Tuberculosis and HIV infection in sub-Saharan Africa. JAMA. 1992 Sep 23-30;268(12):1581-7. doi: 10.1001/jama.268.12.1581.

Reference Type BACKGROUND
PMID: 1518113 (View on PubMed)

Whalen C, Horsburgh CR, Hom D, Lahart C, Simberkoff M, Ellner J. Accelerated course of human immunodeficiency virus infection after tuberculosis. Am J Respir Crit Care Med. 1995 Jan;151(1):129-35. doi: 10.1164/ajrccm.151.1.7812542.

Reference Type BACKGROUND
PMID: 7812542 (View on PubMed)

Goletti D, Weissman D, Jackson RW, Graham NM, Vlahov D, Klein RS, Munsiff SS, Ortona L, Cauda R, Fauci AS. Effect of Mycobacterium tuberculosis on HIV replication. Role of immune activation. J Immunol. 1996 Aug 1;157(3):1271-8.

Reference Type BACKGROUND
PMID: 8757635 (View on PubMed)

Chaisson RE, Clermont HC, Holt EA, Cantave M, Johnson MP, Atkinson J, Davis H, Boulos R, Quinn TC, Halsey NA. Six-month supervised intermittent tuberculosis therapy in Haitian patients with and without HIV infection. Am J Respir Crit Care Med. 1996 Oct;154(4 Pt 1):1034-8. doi: 10.1164/ajrccm.154.4.8887603.

Reference Type BACKGROUND
PMID: 8887603 (View on PubMed)

Small PM, Schecter GF, Goodman PC, Sande MA, Chaisson RE, Hopewell PC. Treatment of tuberculosis in patients with advanced human immunodeficiency virus infection. N Engl J Med. 1991 Jan 31;324(5):289-94. doi: 10.1056/NEJM199101313240503.

Reference Type BACKGROUND
PMID: 1898769 (View on PubMed)

Burman WJ, Jones BE. Treatment of HIV-related tuberculosis in the era of effective antiretroviral therapy. Am J Respir Crit Care Med. 2001 Jul 1;164(1):7-12. doi: 10.1164/ajrccm.164.1.2101133. No abstract available.

Reference Type BACKGROUND
PMID: 11435232 (View on PubMed)

Dean GL, Edwards SG, Ives NJ, Matthews G, Fox EF, Navaratne L, Fisher M, Taylor GP, Miller R, Taylor CB, de Ruiter A, Pozniak AL. Treatment of tuberculosis in HIV-infected persons in the era of highly active antiretroviral therapy. AIDS. 2002 Jan 4;16(1):75-83. doi: 10.1097/00002030-200201040-00010.

Reference Type BACKGROUND
PMID: 11741165 (View on PubMed)

Narita M, Ashkin D, Hollender ES, Pitchenik AE. Paradoxical worsening of tuberculosis following antiretroviral therapy in patients with AIDS. Am J Respir Crit Care Med. 1998 Jul;158(1):157-61. doi: 10.1164/ajrccm.158.1.9712001.

Reference Type BACKGROUND
PMID: 9655723 (View on PubMed)

Lawn SD, Bekker LG, Wood R. How effectively does HAART restore immune responses to Mycobacterium tuberculosis? Implications for tuberculosis control. AIDS. 2005 Jul 22;19(11):1113-24. doi: 10.1097/01.aids.0000176211.08581.5a.

Reference Type BACKGROUND
PMID: 15990564 (View on PubMed)

de Jong BC, Israelski DM, Corbett EL, Small PM. Clinical management of tuberculosis in the context of HIV infection. Annu Rev Med. 2004;55:283-301. doi: 10.1146/annurev.med.55.091902.103753.

Reference Type BACKGROUND
PMID: 14746522 (View on PubMed)

Orlovic D, Smego RA Jr. Paradoxical tuberculous reactions in HIV-infected patients. Int J Tuberc Lung Dis. 2001 Apr;5(4):370-5.

Reference Type BACKGROUND
PMID: 11334257 (View on PubMed)

Related Links

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http://www.cisidat.org.mx/

Consortium for HIV/TB Research in Mexico

Other Identifiers

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C43-06

Identifier Type: -

Identifier Source: org_study_id

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