Pattern of defervescence in response to anti-tuberculosis therapy in patients with extrapulmonary tuberculosis and advanced human immunodeficiency virus infection.
The pattern of fever response to empiric anti-tuberculosis therapy in patients with tuberculosis (TB) and human immunodeficiency virus (HIV) infection, and the relationship between fever response patterns and anti-TB drug susceptibility profiles of Mycobacterium tuberculosis isolates are rarely described. In this study, we evaluated the fever responses to a four-drug anti-TB regimen in 26 HIV-infected patients with culture-proven extrapulmonary TB, and compared the results with those in 12 patients with disseminated Mycobacterium avium complex (DMAC) infection treated with a clarithromycin-containing regimen. The CD4 lymphocyte counts did not differ significantly between TB and DMAC patients (26 x 10(6)/L in TB patients vs 5 x 10(6)/L in DMAC patients). Drug susceptibility data were available for 22 patients with TB. Most TB patients had rapid defervescence after initiation of anti-TB therapy. Fever resolved within 1 week in 85% (22/26) of patients, including three of six (50%) with multidrug-resistant (MDR) TB. The median duration of fever in patients with drug-susceptible TB was similar to that in patients with drug-resistant TB (3 vs 4 days, p = 0.33). However, patients with MDR-TB were more likely than those with non-MDR TB to have fevers lasting longer than 1 week after initiating anti-TB therapy (3/6 vs 1/16, p = 0.046). Only 17% (2/12) of the patients with DMAC infection became afebrile within 1 week of beginning anti-MAC therapy (p < 0.001 vs those with TB). Our observations suggest that in HIV-infected patients with advanced immunosuppression, anti-TB regimens achieve significantly faster defervescence in TB patients than do anti-MAC regimens in DMAC patients. Rapid defervescence in patients with TB does not necessarily indicate that TB isolates are not MDR strains.
Hsieh
S M
SM
Section of Infectious Disease, National Taiwan University Hospital, Taipei.
Sheng
W H
WH
Chen
M Y
MY
Hung
C C
CC
Chang
S C
SC
D017088:AIDS-Related Opportunistic Infections / Q000150:complications / Q000188:drug therapy*; D000328:Adult; D000995:Antitubercular Agents / Q000627:therapeutic use*; D005334:Fever / Q000209:etiology / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015270:Mycobacterium avium-intracellulare Infection / Q000150:complications / Q000188:drug therapy; D014376:Tuberculosis / Q000150:complications / Q000188:drug therapy*; D018088:Tuberculosis, Multidrug-Resistant / Q000150:complications / Q000188:drug therapy
D000995:Antitubercular Agents