Factors that complicate the treatment of tuberculosis in HIV-infected patients.
Treatment of tuberculosis (TB) in persons coinfected with HIV has become increasingly complex during the past decade. We describe the factors that complicate anti-TB therapy in a large observational cohort of HIV-infected persons in the United States. Among 367 HIV-infected patients with 372 episodes of culture-confirmed TB, 44.1% had injection drug use as a mode of HIV transmission. Hepatic disease was present at the time of TB diagnosis or during anti-TB therapy for 91 episodes (24.5%). Elevation at least twice the upper limits of normal of aminotransaminases was observed during the first month of anti-TB therapy in 116 (31.2%) of the episodes. The most commonly reported adverse effects occurring during therapy were rash (27.8%), nausea (26.2%), leukopenia or neutropenia (20.2%), diarrhea (19.3%), vomiting (18.5%), and elevated temperature (>101.5 degrees F [38.6 degrees C], 16.9%). Prescription of a rifamycin and a medication known to interact with rifamycins occurred during 270 (72.6%) episodes. Because HIV-infected patients with TB often have underlying complicating conditions, such as hepatic disease, and are treated with medications that may have toxicities and cause drug-drug interactions, we recommend that clinicians pay careful attention to these factors when treating coinfected patients.
Dworkin
Mark S
MS
National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA. mdworkin@idph.state.il.us
Adams
Michael R
MR
Cohn
David L
DL
Davidson
Arthur J
AJ
Buskin
Susan
S
Horwitch
Carrie
C
Morse
Anne
A
Sackoff
Judy
J
Thompson
Melanie
M
Wotring
Linda
L
McCombs
Scott B
SB
Jones
Jeffrey L
JL
D000995:Antitubercular Agents / Q000008:administration & dosage / Q000009:adverse effects; D015331:Cohort Studies; D024901:Drug Resistance, Multiple, Bacterial; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D008297:Male; D015995:Prevalence; D012307:Risk Factors; D014376:Tuberculosis / Q000150:complications* / Q000188:drug therapy*
D000995:Antitubercular Agents