HIV virologic suppression maintained during latent TB treatment

There are significant barriers in latent TB care among patients with HIV infection, and data are limited regarding the safety and effectiveness of coadministered treatments in patients with both conditions.

To bridge this gap in clinical data, investigators conducted a retrospective cohort study at 16 hospitals in Taiwan between 2019 and 2022. Eligible patients (N=479; age, ≥20 years) included those with HIV infection receiving INSTI-containing ART in combination with rifapentine plus isoniazid, administered either once daily for 1 month (1HP; n=205) or once weekly for 3 months (3HP; n=274). The primary outcome was virologic response (HIV viral load, <200 copies/mL) within 12 months of latent TB treatment completion. Logistic regression was used to identify factors associated with virologic response and adverse events (AEs).

Patients in the 1HP and 3HP cohorts were a median age of 43 and 43 years, 94.1% and 94.9% were men, 75.6% and 57.7% were men who have sex with men (P <.001), 13.7% and 34.3% used illicit drugs (P <.001), and 3.9% and 11.7% were incarcerated at latent TB treatment initiation (P =.002), respectively.

During latent TB treatment, receipt of bictegravir-based ART regimens was more common among patients in the 1HP cohort (69.3% vs 13.9%), whereas dolutegravir-based ART was more common among those in the 3HP cohort (78.1% vs 22.4%). Overall, 39 (8.1%) patients reported use of other types of ART regimens.

The primary outcome was achieved by 96.5% and 95.8% of patients receiving dolutegravir-based ART in the 1HP and 3HP cohorts, respectively, and 100% of the remaining patients in both cohorts receiving bictegravir-based ART or other ART regimens.

In a univariate analysis, factors significantly associated with failure to maintain HIV virologic response were as follows:

• Incarceration (odds ratio [OR], 18.04; 95% CI, 5.90-55.17; P <.001);
• Illicit drug use (OR, 3.62; 95% CI, 1.23-10.67; P =.020);
• Antihepatitis C virus positivity (OR, 3.47; 95% CI, 1.19-10.12; P =.023);
• Baseline viral load (per 1-log₁₀ copies/mL increase; OR, 1.71; 95% CI, 1.05-2.77; P =.031); and
• Baseline CD4⁺ count (per 10-cell/mm³ increase; OR, 0.98; 95% CI, 0.95-1.00; P =.040).

However, after adjustment for confounders, only incarceration remained significantly associated with failure to maintain HIV virologic response (adjusted OR, 12.67; 95% CI, 2.92-54.98; P =.001).

Overall, 92.7% and 90.5% of patients in the 1HP and 3HP cohorts, respectively, completed latent TB treatment. In both cohorts, the percentage of patients who completed the full treatment course was higher among those receiving bictegravir- (range, 95.8%-97.4%) vs dolutegravir-based ART (range, 87.0%-88.3%).

The most common reason for treatment noncompletion among patients in the 1HP and 3HP cohorts was discontinuation due to AEs (6.3% and 7.7%, respectively). Most AEs occurred at similar rates between patients in the 1HP vs 3HP cohorts, with the exception of dermatologic (17.6% vs 9.1%; P =.009), new hepatic (17.1% vs 10.6%; P =.010), and Grade 3 events (7.8% vs 2.6%; P =.008).

Limitations of this study include the retrospective design and imbalanced clinical characteristics between the patient cohorts.

According to the investigators, “The high completion rate observed with short-course rifapentine-based regimens for LTBI [latent TB infections] among [people with HIV] has the potential to enhance LTBI treatment outcomes in this population.”

Disclosures: Multiple study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.

By Jessica Nye, PhD

References:

Lin K-Y, Sun H-Y, Yang C-J, et al. Treatment responses to integrase strand-transfer inhibitor-containing antiretroviral regimens in combination with short-course rifapentine-based regimens for latent tuberculosis infection among people with HIV. Clin Infect Dis. Published online December 5, 2023. doi:10.1093/cid/ciad730

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