Title: Retrospective cohort analysis of antiretroviral therapy initiation timelines and clinical outcomes in adults with HIV and TB disease in KwaZulu-Natal, South Africa
Authors: Jansen van Vuuren C, van der Molen J, Sookrajh Y, Ngwenya T, Khubone T, Mkhize S, Asare K, Naidoo K, Lessells R, Lewis L, Garrett N, Dorward J.
Journal: International Journal of STD & AIDS,37:14-23 (2026)
Abstract
Background
We aimed to determine antiretroviral therapy (ART) initiation timing and outcomes in people living with HIV (PLHIV) receiving tuberculosis treatment in KwaZulu-Natal, South Africa.
Methods
We performed a retrospective cohort analysis of routinely collected de-identified data from 62 clinics including PLHIV not already receiving ART aged ?16Â years, starting tuberculosis treatment between October 2016âNovember 2019. Multivariable Poisson regression models with robust standard errors evaluated associations between timing of ART initiation (after starting tuberculosis treatment) and successful tuberculosis treatment, and 6-month HIV viral load (VL) < 50Â copies/mL.
Results
Among 5,548 PLHIV with tuberculosis, 29.8% initiated ART within 15Â days (âearlyâ), 36.2% in 16â56Â days, 8.7% in 57â210Â days, with 25.3% not initiating ART by 7Â months. Proportions with successful tuberculosis treatment were similar comparing 16â56 and 57â210Â days to early initiation, with a lower likelihood of successful tuberculosis outcome with no ART within 7Â months (adjusted risk ratio [aRR] 0.81 [0.77â0.86],
p
< 0.001). In those with a known VL 6Â months post-ART initiation (
n
= 2,658), initiation within 57â210 days had a lower likelihood of viral suppression (aRR 0.90 [0.82â0.99],
p
< 0.03).
Conclusion
Although <30% of PLHIV with tuberculosis initiated ART early, this was associated with better tuberculosis outcomes and VL suppression.