Tuberculosis and Human Immunodeficiency Virus (HIV) Immune Reconstitution Syndrome Trial (THIRST)

• Number of Serious Adverse Events (SAEs) [ Time Frame: 104 weeks ] [ Designated as safety issue: Yes ]
  Feasibility and safety of fixed dose combination zidovudine/lamivudine/abacavir in HIV-infected subjects with tuberculosis in a resource-limited setting as assessed by the number of serious adverse events. Serious adverse events included any untoward medical occurrence that resulted in death, was considered life-threatening, required inpatient hospitalization or prolongation of existing hospitalization beyond what was required in the study, or resulted in persistent or resulted in significant disability/incapacity.
• Tuberculosis-immune Reconstitution Inflammatory Syndrome Events [ Time Frame: 104 weeks ] [ Designated as safety issue: Yes ]
  Tuberculosis-immune reconstitution inflammatory syndrome was defined by the protocol as: a) new persistent fevers (temperature >101.5 degrees Fahrenheit) developing after the initiation of antiretroviral therapy, and not believed to be associated with antiretroviral therapy and without an identifiable source, b) marked worsening or emergence of intrathoracic lymphadenopathy, pulmonary infiltrates or pleural effusions on radiologic examination, or c) worsening or emergence of lymphadenopathy on serial examinations or worsening of other tuberculous lesions.

• Feasibility and safety of fixed dose combination zidovudine/lamivudine/abacavir in HIV-infected subjects with tuberculosis in a resource-limited setting. [ Time Frame: 104 weeks ] [ Designated as safety issue: Yes ]
• To assess the impact of delayed versus early initiation strategy for fixed-dose combination zidovudine/lamivudine/abacavir on the rate of tuberculosis-immune reconstitution inflammatory syndromes [ Time Frame: 104 weeks ] [ Designated as safety issue: Yes ]

• Plasma HIV Ribonucleic Acid (RNA) Level < 400 Copies/ml [ Time Frame: 104 Weeks ] [ Designated as safety issue: No ]
  The number of subjects with plasma HIV RNA level <400 copies/ml.
• HIV RNA Level < 50 Copies/ml [ Time Frame: 104 Weeks ] [ Designated as safety issue: No ]
  The number of subjects with plasma HIV RNA level <50 copies/ml.

The purpose of this study is twofold: (1) to assess the feasibility and safety of fixed dose combination zidovudine/lamivudine/abacavir in HIV infected subjects with tuberculosis in a resource-limited setting, and (2) to assess the impact of delayed versus early initiation strategies for fixed dose combination zidovudine/lamivudine/abacavir on the rate of tuberculosis-associated immune reconstitution inflammatory syndromes.

• HIV
• Tuberculosis

• Experimental: Early
  Initiation of fixed dose combination zidovudine/lamivudine/abacavir 2 weeks after commencing antituberculous therapy
  Intervention: Drug: Fixed dose combination zidovudine/lamivudine/abacavir
• Experimental: Delayed
  Initiation of fixed dose combination zidovudine/lamivudine/abacavir 8 weeks after commencing antituberculous therapy
  Intervention: Drug: Fixed dose combination zidovudine/lamivudine/abacavir

Inclusion Criteria:

• HIV Infection is documented by rapid HIV test or any licensed enzyme-linked immunosorbent assay (ELISA) test kit and confirmed with a different sample.
• Men or women admitted to Kibongoto or Marangu Hospitals with (a) recent (within 56 days) smear positive tuberculosis (pulmonary or extrapulmonary,) (b)total lymphocyte count <1,200/mm3, and (c) less than 14 days of antituberculous therapy.
• Antiretroviral naive with the exception of regimens used to prevent mother-to-infant transmission of HIV during pregnancy.
• The following laboratory values obtained within 45 days prior to study entry: absolute neutrophil count (ANC) >=700/mm³, hemoglobin > 8 g/dL in women; >9 g/dL in men, serum creatinine <= 1.5 times upper limits of normal, AST <5 times upper limits of normal.
• For all women of reproductive potential (who have not reached menopause or undergone hysterectomy, bilateral oophorectomy, or tubal ligation), a negative urine pregnancy test within 48 hours of to study.
• All subjects must agree not to participate in a conception process (e.g., active attempt to become pregnant or to impregnate) and if participating in sexual activity that could lead to pregnancy, the female subject/male partner must use condoms (male or female) without a spermicidal agent.
• Not intending to relocate out of area for the duration of study participation.
• Willingness of subject to adhere to follow up schedule.
• Men and women >= age 13.
• Ability and willingness of subject or legal guardian/representative to give written consent.

Exclusion Criteria:

• Serious illness, other than tuberculosis, that requires systematic treatment and/or hospitalization, until either completion of therapy or clinical stability on therapy in the opinion of the investigator for at least 14 days prior to study entry. Oral and vaginal candidiasis, mucocutaneous herpes simples, and other illnesses which are minor in the opinion of the site investigator are exceptions
• Diagnosis of or suspicion of tuberculosis of the central nervous system.
• > 14 days of antituberculous therapy prior to screening.
• > 28 days of antituberculous therapy for active tuberculosis within the 6 months prior to screening.
• Recent past (within 28 days of study entry) or planned use of corticosteroids.
• Any condition that in the opinion of the investigator would compromise the subject's ability to participate in the study.
• Radiation or systemic chemotherapy within 45 days of entry.
• Any immunomodulator, HIV vaccine, or other investigational therapy within 30 days prior to study entry.
• Active drug or alcohol use or dependence that, in the opinion of the investigator, would interfere with adherence to study requirements.
• Allergy/sensitivity to any study drugs or their formulations.

• Kilimanjaro Christian Medical Centre, Tanzania
• Kibongoto National Tuberculosis Hospital, Tanzania
• GlaxoSmithKline