Effectiveness of supervised, intermittent therapy for tuberculosis in HIV-infected patients.
OBJECTIVE
To evaluate the effectiveness of supervised therapy for tuberculosis (TB) in patients with HIV infection.


METHODS
Retrospective, chart review.


METHODS
Patients with TB and HIV infection.


METHODS
Urban, public TB clinic.


RESULTS
A total of 107 patients with TB and HIV infection were studied. Most were men (78%), African American (91%), uninsured or on Medicaid (88%), and 67% were injecting drug users. TB was diagnosed before AIDS in 31% of subjects, at the time of AIDS in 32%, and after AIDS in 37%. Clinical features varied by stage of HIV disease. Sixteen patients received no therapy and died before TB was diagnosed, 10 died during the first 8 weeks of treatment. Seventy-eight patients received > 8 weeks therapy, of whom 48 (62%) were given directly observed therapy twice weekly and 30 (38%) received self-administered daily therapy. Patients who received directly observed therapy were more likely to complete 6 months of therapy (96 versus 76%, P = 0.02) and more likely to survive after therapy ended (85 versus 57%, P = 0.01). By logistic regression, directly observed therapy, AIDS diagnosed before TB, and age were significantly associated with survival outcome.


CONCLUSIONS
Directly observed therapy for TB in patients with HIV infection is highly effective and associated with better adherence to therapy and survival.
Alwood
K
K
Johns Hopkins University School of Medicine, Baltimore, MD 21205.
Keruly
J
J
Moore-Rice
K
K
Stanton
D L
DL
Chaulk
C P
CP
Chaisson
R E
RE
D017088:AIDS-Related Opportunistic Infections / Q000188:drug therapy* / Q000401:mortality; D000163:Acquired Immunodeficiency Syndrome / Q000453:epidemiology / Q000401:mortality; D000328:Adult; D001741:Black or African American; D000367:Age Factors; D000995:Antitubercular Agents / Q000627:therapeutic use; D018791:CD4 Lymphocyte Count; D005260:Female; D006679:HIV Seropositivity / Q000453:epidemiology; D006801:Humans; D008297:Male; D008484:Medicaid; D017057:Medically Uninsured; D011336:Probability; D012189:Retrospective Studies; D012307:Risk Factors; D015819:Substance Abuse, Intravenous; D015996:Survival Rate; D016896:Treatment Outcome; D014376:Tuberculosis / Q000188:drug therapy* / Q000401:mortality; D014481:United States; D044465:White People
D000995:Antitubercular Agents