Impact of Antiretroviral Therapy on Anemia, Hepatotoxicity, and Immune Reconstitution Inflammatory Syndrome in HIV-Tuberculosis Co-Infected Patients

IntroductionHIV continues to pose a significant global health challenge, causing gradual immune system decline and, if left untreated, progressing to AIDS. Although antiretroviral therapy (ART) has transformed the treatment landscape for HIV, it is frequently associated with adverse effects, including anemia, hepatotoxicity, and immune-related issues such as Immune Reconstitution Inflammatory Syndrome (IRIS), particularly in patients co-infected with tuberculosis (TB). Materials and methodsIn this prospective cohort study, 400 ART-naive, HIV-positive patients undergoing anti-tuberculosis therapy (ATT) at King Georges Medical University, Lucknow, India, were enrolled. The study evaluated the occurrence of opportunistic infections (OIs), ART regimen effectiveness, and key laboratory markers, including CD4 counts and hemoglobin levels. ResultsTB emerged as the most common OI, affecting 20.25% of the participants, with anemia present in 85% of the cohort. The prevalence of IRIS was notably higher in patients with a positive tuberculin skin test (20.6%) compared to those with a negative test (7.4%). Patients with IRIS exhibited significantly lower CD4 counts and hemoglobin levels compared to those without IRIS. ConclusionThis study underscores the importance of integrated management approaches for HIV patients co-infected with TB, focusing on the complex interaction between immune status, ART effectiveness, and comorbidities like anemia and hepatotoxicity. Properly addressing these factors is crucial for improving patient outcomes in this high-risk population.