title: Evolution of rifampin resistance in human immunodeficiency virus-associated tuberculosis.
abstract: Acquired rifampin resistance without preexisting isoniazid resistance is highly unusual in patients with tuberculosis. The purpose of this report is to describe and characterize that unusual pattern of acquired drug resistance in three patients with human immunodeficiency virus (HIV) infection. The patients originally had Mycobacterium tuberculosis strains that were susceptible to isoniazid and rifampin. During treatment in two patients and after completion of therapy in the remaining one, each patient developed active, rifampin-resistant, isoniazid-susceptible tuberculosis. One patient subsequently developed isoniazid resistance also. Studies on patients' M. tuberculosis isolates using IS6110 restriction fragment length polymorphism typing and rpoB gene sequencing indicated that rifampin resistance in each patient arose during therapy by an rpoB gene mutation in the original M. tuberculosis isolate. Detection of this unusual drug-resistance phenotype in three patients with HIV infection suggests that acquired rifampin resistance is somehow associated with co-infection due to HIV and tuberculosis.
authors.affiliation: Seattle-King County Department of Public Health, University of Washington, Seattle 98104, USA.
authors.forename: C M
authors.initials: CM
authors.lastname: Nolan
authors.forename: D L
authors.initials: DL
authors.lastname: Williams
authors.forename: M D
authors.initials: MD
authors.lastname: Cave
authors.forename: K D
authors.initials: KD
authors.lastname: Eisenach
authors.forename: H
authors.initials: H
authors.lastname: el-Hajj
authors.forename: T M
authors.initials: TM
authors.lastname: Hooton
authors.forename: R L
authors.initials: RL
authors.lastname: Thompson
authors.forename: S V
authors.initials: SV
authors.lastname: Goldberg
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000188:drug therapy* / Q000382:microbiology; D000328:Adult; D001483:Base Sequence; D004269:DNA, Bacterial / Q000032:analysis*; D004352:Drug Resistance, Microbial / Q000235:genetics; D017809:Fatal Outcome; D006801:Humans; D007538:Isoniazid / Q000494:pharmacology; D008297:Male; D008875:Middle Aged; D008969:Molecular Sequence Data; D009169:Mycobacterium tuberculosis / Q000187:drug effects* / Q000235:genetics*; D016133:Polymerase Chain Reaction; D012150:Polymorphism, Restriction Fragment Length; D012293:Rifampin / Q000494:pharmacology*; D018088:Tuberculosis, Multidrug-Resistant / Q000188:drug therapy* / Q000382:microbiology; D014397:Tuberculosis, Pulmonary / Q000188:drug therapy* / Q000382:microbiology
chemical_list: D004269:DNA, Bacterial; D007538:Isoniazid; D012293:Rifampin