Efficacy of an unsupervised 8-month rifampicin-containing regimen for the treatment of pulmonary tuberculosis in HIV-infected adults. Uganda-Case Western Reserve University Research Collaboration.
METHODS
National Tuberculosis Treatment Centre, Mulago Hospital, Kampala, Uganda.


OBJECTIVE
To assess the efficacy of a daily, self-administered 8-month rifampicin-containing regimen for the treatment of pulmonary tuberculosis (TB) in human immunodeficiency virus (HIV) infected adults.


METHODS
Treatment outcomes in patients with pulmonary TB treated with a single 8-month regimen and followed in a prospective epidemiological study.


RESULTS
Two hundred and sixty-five HIV-infected and 26 non-HIV-infected adults with initial episodes of pulmonary tuberculosis were treated with 2 months of daily isoniazid (INH), rifampicin (RMP), ethambutol and pyrazinamide followed by 6 months of daily INH + RMP. Median follow-up was 17.8 months. Ninety-five per cent of the HIV-infected and all of the non-HIV-infected patients who had sputum examined were sputum culture negative after 2 months of treatment. Twenty-two HIV-infected and no non-HIV-infected patients died during treatment. Relapse rates were 8.4% (5.9 per 100 person-years of observation [PYO], 95%CI 3.2-8.6) among HIV-infected patients and 4.5% (2.1/100 PYO, 95%CI 0-7.8) for non-HIV-infected patients. Adverse drug reactions occurred in 37% of the HIV-infected patients; most were minor and self-limiting.


CONCLUSIONS
An 8-month RMP-containing regimen was well tolerated and effective in the treatment of HIV-infected adults with initial episodes of pulmonary TB. Relapse rates were similar to those reported with 6-month short-course regimens in HIV-infected individuals. Decisions about the duration of anti-tuberculosis treatment for HIV-infected adults must balance programme resources and the likelihood of poor compliance with longer regimens with the potential for a modest decrease in relapses with longer treatment.
Johnson
J L
JL
Department of Medicine, Case Western Reserve University School of Medicine and University Hospitals of Cleveland, Ohio 44106-4984, USA. jlj@po.cwru.edu
Okwera
A
A
Nsubuga
P
P
Nakibali
J G
JG
Whalen
C C
CC
Hom
D
D
Cave
M D
MD
Yang
Z H
ZH
Mugerwa
R D
RD
Ellner
J J
JJ
D017088:AIDS-Related Opportunistic Infections / Q000188:drug therapy*; D000328:Adult; D000904:Antibiotics, Antitubercular / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008297:Male; D011446:Prospective Studies; D012293:Rifampin / Q000627:therapeutic use*; D014397:Tuberculosis, Pulmonary / Q000188:drug therapy*; D014454:Uganda
D000904:Antibiotics, Antitubercular; D012293:Rifampin