Clinical course of human immunodeficiency virus type 1 associated pulmonary tuberculosis during short-course antituberculosis therapy.
To describe the clinical response to antituberculosis therapy in HIV-1 disease, 49 HIV-1 positive Ugandan adults (mean age 29.4 years; 68% men) with active pulmonary tuberculosis (PTB) were studied in a trial of rifampicin containing short-course antituberculosisis regimens. At presentation, 18 patients were PPD non-reactors (PPD skin test induration < 2mm), ten patients (20%) had non-cavitary lung disease. The mean CD4 lymphocyte count at presentation was 339/microliters (+/- SD 275). Among patients with abnormal baseline clinical values, the median time to resolution of fever, weight gain of 10%, increase of haemoglobin to 10g/dl and of Karnofsky performance score (KPS) to 80 occurred before sputum smear and culture conversion. Short-term survival was associated with: baseline lymphocytes < 1200/microliters, (Odds ratio (OR) 17.5), CD4+ lymphocytes < 200/microliters (OR 9.8), cavitary lung disease, (OR 0.6), atypical chest radiograph, (OR 6.7), and PPD non-reactivity, (OR 13.5), PPD non-reactivity and non-cavitary disease were associated with significantly lower CD4 lymphocyte counts. Affordable serial measurements parallel the response to therapy and predict survival in HIV-associated PTB.
Schwander
S K
SK
Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany.
Dietrich
M
M
Mugyenyi
P
P
Kityo
C
C
Okwera
A
A
Johnson
J
J
Nsubuga
P
P
Ruesch-Gerdes
S
S
Whalen
C
C
D017088:AIDS-Related Opportunistic Infections / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000276:immunology*; D000328:Adult; D000368:Aged; D000904:Antibiotics, Antitubercular / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D018450:Disease Progression; D005260:Female; D006679:HIV Seropositivity / Q000276:immunology*; D015497:HIV-1; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011859:Radiography; D012293:Rifampin / Q000627:therapeutic use*; D016019:Survival Analysis; D014374:Tuberculin Test; D014397:Tuberculosis, Pulmonary / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000276:immunology*; D014454:Uganda
D000904:Antibiotics, Antitubercular; D012293:Rifampin