Influence of treatment and immunological recovery on tuberculosis relapses in HIV-infected patients.
METHODS
Studies on tuberculosis (TB) relapse in HIV-infected patients show contradictory results regarding the optimal duration of treatment.


OBJECTIVE
To assess the incidence of TB relapse and associated factors in HIV-infected patients receiving a 9-month tuberculostatic regimen and concomitant HAART.


METHODS
Observational prospective study recording 156 episodes of TB in 137 patients, most of whom were on a 9-month regimen of daily isoniazid and rifampicin-based TB treatment. The primary outcome measure was relapse after completion of therapy.


RESULTS
Forty episodes were excluded due to death or loss to follow-up. The median follow-up was 24 months. Twenty-seven episodes of TB relapse were observed in 22 patients, yielding a relapse rate of 1.9/100 patient-years in those on a regimen of > or = 9 months. A high recurrence rate was observed in those who had prematurely suspended treatment. Treatment duration > or = 9 months and achieving both an undetectable viral load and increasing CD4-cell counts with HAART were associated with the absence of TB relapses.


CONCLUSIONS
Considering its safety and tolerance, our results suggest that a 9-month regimen would be recommendable in patients with severe immunosuppression until the optimal duration of TB treatment in HIV-infected patients has been defined in a randomised clinical trial including HAART.
Lopez-Cortes
L F
LF
Department of Infectious Diseases Service, Hospitales Universitarios Virgen del Rocío, Seville, Spain. lflopez@telefonica.net
Marin-Niebla
A
A
Lopez-Cortes
L E
LE
Villanego
I
I
Rodriguez-Diez
M
M
Pascual-Carrasco
R
R
D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D000995:Antitubercular Agents / Q000008:administration & dosage*; D018791:CD4 Lymphocyte Count; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy / Q000276:immunology*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D011446:Prospective Studies; D012008:Recurrence; D012307:Risk Factors; D014376:Tuberculosis / Q000150:complications / Q000188:drug therapy* / Q000276:immunology*
D000995:Antitubercular Agents