Relapse rates after short-course (6-month) treatment of tuberculosis in HIV-infected and uninfected persons.
OBJECTIVE
To determine the rate of tuberculosis relapse among HIV-seropositive and -seronegative persons treated for active tuberculosis with short-course (6-month) therapy.


METHODS
Consecutive cohort study.


METHODS
City of Baltimore tuberculosis clinic.


METHODS
Tuberculosis patients treated between 1 January 1993 and 31 December 1996.


METHODS
Patients received 2 months of isoniazid, rifampin, pyrazinamide and ethambutol followed by 4 months of isoniazid and rifampin.


METHODS
Passive follow-up for tuberculosis relapse was performed through September 30, 1998.


RESULTS
There were 423 cases of tuberculosis during the study period; 280 patients completed a 6-month course of therapy. Therapy was directly-observed for 94% of patients. Of those who completed therapy, 47 (17%) were HIV-seropositive, 127 (45%) were HIV-seronegative, and 106 (38%) had unknown HIV status. HIV-infected patients required more time to complete therapy (median 225 versus 205 days; P = 0.04) but converted sputum culture to negative within the same time period (median 77 versus 72 days; P = 0.43) as HIV-seronegative or unknown patients. Relapse occurred in three out of 47 (6.4%) HIV-infected patients compared to seven out of 127 (5.5%) HIV-seronegative patients (P = 1.0). Relapse rates also did not differ when HIV-seropositive patients were compared with HIV-seronegative and patients with unknown HIV status (6.4% versus 3.0%; P = 0.38). Of the 10 patients with tuberculosis relapse, restriction fragment length polymorphism data were available for five; all five relapse isolates matched the initial isolate.


CONCLUSIONS
These results support current recommendations to treat tuberculosis in HIV-infected patients with short-course (6-month) therapy.
Sterling
T R
TR
Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Alwood
K
K
Gachuhi
R
R
Coggin
W
W
Blazes
D
D
Bishai
W R
WR
Chaisson
R E
RE
D017088:AIDS-Related Opportunistic Infections / Q000188:drug therapy* / Q000503:physiopathology; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000995:Antitubercular Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D004977:Ethambutol / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007538:Isoniazid / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D011718:Pyrazinamide / Q000627:therapeutic use*; D012008:Recurrence; D012293:Rifampin / Q000627:therapeutic use*; D013997:Time Factors; D014376:Tuberculosis / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology
D000995:Antitubercular Agents; D011718:Pyrazinamide; D004977:Ethambutol; D007538:Isoniazid; D012293:Rifampin