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1 February 2005

Volume 191, Number 3
The Journal of Infectious Diseases 2005;191:324–332
© 2004 by the Infectious Diseases Society of America. All rights reserved.
0022-1899/2005/19103-0002$15.00
DOI: 10.1086/427337
MAJOR ARTICLE

Therapeutic Response of HIV‐1 Subtype C in African Patients Coinfected with either Mycobacterium tuberculosis or Human Herpesvirus–8

Edana Cassol,1,2

Taryn Page,1

Anisa Mosam,3

Gerald Friedland,6

Chris Jack,4

Umesh Lalloo,4

Joe Kopetka,7

Bruce Patterson,8

Tonya Esterhuizen,5 and

Hoosen M. Coovadia2

1HIV‐1 Molecular Virology and Bioinformatics Unit, Africa Centre for Health and Population Studies, and 2Centre for HIV/AIDS Networking, Doris Duke Medical Research Institute, and Departments of 3Dermatology and 4Medicine, Nelson R. Mandela School of Medicine, and 5Faculty of Health Sciences, University of KwaZulu‐Natal, Durban, South Africa; 6Yale University School of Medicine, New Haven, Connecticut; 7Invirion Inc., Frankfort, Michigan; 8Department of Clinical Virology, Stanford University, School of Medicine, Palo Alto, California

Background.A potential confounding factor in the treatment of human immunodeficiency virus (HIV) infection in Africa is the frequent occurrence of opportunistic infections (OIs). OI‐induced immune activation can interfere with HIV‐1 clearance by increasing viral replication and target cell availability.

Study design.Treatment outcomes for patients dually infected with HIV‐1 and Mycobacterium tuberculosis or HIV‐1 and human herpesvirus (HHV)–8 were assessed by measuring changes in viral load and CD4+ cell counts and by determining the time taken to reach undetectable HIV‐1 RNA levels, assessed by means of Kaplan‐Meier survival analysis. Patients with HIV‐1 and Kaposi sarcoma (KS) received generic nevirapine, stavudine, and lamivudine (3TC); patients with HIV‐1 and tuberculosis (TB) received standard commercial didanosine, 3TC, and efavirenz.

Results.Both cohorts exhibited a rapid, near‐exponential phase I decline in viral load. Patients with TB and late‐stage KS had the steepest decay kinetics. These same patients had the greatest initial increase in CD4+ cell counts. Phase II clearance was slower and more variable. The proportions of patients reaching undetectable plasma HIV‐1 levels at days 7, 14, 28, 60, and 90 were, respectively, 15.8%, 30.0%, 52.6%, 78.9%, and 93.8% (Pearson's ; ) for patients with TB and 0.0%, 5.0%, 22.2%, 64.7%, and 80.0% (Pearson's ; ) for patients with KS.

Conclusions.Nucleoside reverse‐transcriptase inhibitor/nonnucleoside reverse‐transcriptase inhibitor–based treatment regimens are highly effective in clearing rapidly replicating (phase I) virus in African patients dually infected with HIV‐1 and either TB or KS.

Received 25 April 2004; accepted 8 July 2004; electronically published 22 December 2004.

Reprints or correspondence: Dr. Edana Cassol, HIV‐1 Molecular Virology and Bioinformatics Unit, Africa Centre for Health and Population Research, Doris Duke Medical Research Institute, Nelson R. Mandela School of Medicine, University of KwaZulu‐Natal, Durban, South Africa ().

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  • Financial support: Wellcome Trust, United Kingdom (programme grant 061238).

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