PLoS ONE (Jan 2011)

Will adoption of the 2010 WHO ART guidelines for HIV-infected TB patients increase the demand for ART services in India?

  • Ajay M V Kumar,
  • Devesh Gupta,
  • B B Rewari,
  • Damodar Bachani,
  • Suresh Mohammed,
  • Vartika Sharma,
  • Kumaraswamy Lal,
  • H R Raveendra Reddy,
  • Balaji Naik,
  • Rita Prasad,
  • Mohammed Yaqoob,
  • K G Deepak,
  • Suresh Shastri,
  • Srinath Satyanarayana,
  • Anthony David Harries,
  • Lakhbir Singh Chauhan,
  • Puneet Dewan

DOI
https://doi.org/10.1371/journal.pone.0024297
Journal volume & issue
Vol. 6, no. 9
p. e24297

Abstract

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BACKGROUND: In 2010, WHO expanded previously-recommended indications for anti-retroviral treatment to include all HIV-infected TB patients irrespective of CD4 count. India, however, still limits ART to those TB patients with CD4 counts <350/mm(3) or with extrapulmonary TB manifestations. We sought to evaluate the additional number of patients that would be initiated on ART if India adopted the current 2010 WHO ART guidelines for HIV-infected TB patients. METHODS: We evaluated all TB patients recorded in treatment registers of the Revised National TB Control Programme in June 2010 in the high-HIV prevalence state of Karnataka, and cross-matched HIV-infected TB patients with ART programme records. RESULTS: Of 6182 TB patients registered, HIV status was ascertained for 5761(93%) and 710(12%) were HIV-infected. 146(21%) HIV-infected TB patients were on ART prior to TB diagnosis. Of the remaining 564, 497(88%) were assessed for ART eligibility; of these, 436(88%) were eligible for ART according to 2006 WHO ART guidelines. Altogether, 487(69%) HIV-infected TB patients received ART during TB treatment. About 80% started ART within 8 weeks of TB treatment and 95% received an efavirenz based regimen. CONCLUSION: In Karnataka, India, about nine out of ten HIV-infected TB patients were eligible for ART according to 2006 WHO ART guidelines. The efficiency of HIV case finding, ART evaluation, and ART initiation was relatively high, with 78% of eligible HIV-infected patients actually initiated on ART, and 80% within 8 weeks of diagnosis. ART could be extended to all HIV-infected TB patients irrespective of CD4 count with relatively little additional burden on the national ART programme.