Discovery: Combining HIV and TB treatments effective for those living with the virus
TB is still the world’s leading infectious disease killer. People who have HIV/Aids and TB have reduced immunity, especially if not on treatment. PHOTO | FOTOSEARCH
What you need to know:
- The results, which show the safety of starting DTG-based ART and 3HP TB preventive treatment at the same time, were presented at the 2024 Conference on Retroviruses and Opportunistic Infections (CROI).
- The study highlights the use of short-course TB preventive treatment in people newly diagnosed with HIV and at highest risk of active TB disease.
Combining antiretroviral therapy with tuberculosis prevention treatment is safe and effective for people living with HIV, a new study has found.
The new clinical trial results show that the best treatment for HIV works well with one of the best treatments for tuberculosis (TB), adding that combining the treatments can help solve the TB-HIV co-infection crisis that affects more than half a million people.
The study looked at people who have not yet started treatment for HIV and assessed how dolutegravir (DTG)-based antiretroviral therapy (ART) works when taken with 3HP, a short, three-month course of isoniazid and rifapentine.
The results, which show the safety of starting DTG-based ART and 3HP TB preventive treatment at the same time, were presented at the 2024 Conference on Retroviruses and Opportunistic Infections (CROI).
The study highlights the use of short-course TB preventive treatment in people newly diagnosed with HIV and at highest risk of active TB disease.
The study, called "DOLPHIN-TOO", focused on DTG drug levels in the blood of people living with HIV who had never been treated with ART and were taking TB preventive treatment 3HP or six months of isoniazid (6H).
The patients started TB treatment at the same time as they started DTG. The study focused on whether the levels of DTG in the blood were affected by the TB treatment.
Studies have shown that the TB treatment, which is a fixed-dose combination therapy of two antibiotics - isoniazid and rifapentine - to treat latent TB, is preferred by patients, has less toxicity and is easier for patients to complete than the longer courses of isoniazid (which can last up to a year in some places).
The results showed that people in the TB treatment group achieved viral suppression (undetectable levels of HIV in the blood) after eight weeks and maintained it for the duration of the six-month trial.
Side effects were minimal, none were severe and most resolved with continued treatment.
Each year, there are an estimated 670,000 new cases of TB among people living with HIV and an estimated 167,000 deaths from TB-related HIV. In Kenya, the TB-HIV co-infection rate was 25 per cent in 2020, down from 26 in 2019, but the positivity rate was higher among women at 32 per cent compared to men at 21 per cent.
In addition, HIV positivity was 26 per cent among adults and 14 per cent among children. ART uptake among co-infected patients was 97 per cent, with Homa Bay County reporting 100 per cent ART uptake, according to data from the Centre for Health Solutions, Kenya.
Previous research, presented at the Union World Conference on Lung Health in November 2023, had provided information on the safety and efficacy of using 3HP and DTG together, without data on drug levels in the blood.
"An ounce of prevention is worth a pound of cure, and whenever possible, it's best to get that ounce early," said Ethel Weld, assistant professor of medicine at the Johns Hopkins University School of Medicine and the study's principal investigator.
"This study looked at the safety, efficacy and drug levels of DTG when given at the start of TB preventive treatment in new HIV patients. Although an expected interaction was seen, DTG still held down HIV viral loads and the combination was safe and well tolerated," he said.
"For HIV patients, the best time to start TB preventive treatment is when they first start ART," said Professor Gavin Churchyard, Group CEO of the Aurum Institute. "This is when patients are most closely monitored and are in regular contact with clinics and healthcare providers, making it easier to monitor them for any potential side effects.
He adds: "Seeing how safe and effective the simultaneous initiation of 3HP and DTG-based ART is, this approach needs to be adopted in every country where TB is prevalent. The only way to end TB is to systematically prevent new TB cases in people living with HIV in the first place - and we now have the prescription".
The findings will inform WHO and country-level policy on the timing of TB preventive treatment for people newly starting DTG-based ART in high-burden TB countries worldwide. It gives programmes the green light to fully integrate 3HP into the care of people living with HIV from the start of HIV treatment.
The study recommends that governments should feel confident in using 3HP in HIV programmes, and that donors, including the President's Emergency Plan for AIDS Relief (PEPFAR) and the Global Fund, should support countries in procuring 3HP as an essential part of the HIV clinical care package.
The study was funded by Unitaid as part of the IMPAACT4TB project.
