Treatment outcomes of patients with HIV and tuberculosis.
BACKGROUND
The optimal length of tuberculosis treatment in patients coinfected with HIV is unknown.


OBJECTIVE
To evaluate treatment outcomes for HIV-infected patients stratified by duration of rifamycin-based tuberculosis therapy.


METHODS
We retrospectively reviewed data on all patients with tuberculosis reported to the San Francisco Tuberculosis Control Program from 1990 through 2001. Patients were followed for up to 12 months after treatment completion.


RESULTS
Of 700 patients, 264 (38%) were HIV infected, 315 (45%) were not infected, and 121 (17%) were not tested. Mean duration of treatment was extended to 10.2 months for HIV-infected patients versus 8.4 months for uninfected/unknown patients (p < 0.001). Seventeen percent of the HIV-infected and 37% of the HIV uninfected/unknown patients received 6 months of rifamycin-based therapy. The relapse rate among HIV-infected was 9.3 per 100 person-years versus 1.0 in HIV-uninfected/unknown patients (p < 0.001). HIV-infected individuals who received a standard 6-month rifamycin-based regimen were more likely to relapse than those treated longer (adjusted hazard ratio, 4.33; p = 0.02). HIV-infected individuals who received intermittent therapy were also more likely to relapse than those treated on daily basis (adjusted hazard ratio, 4.12; p = 0.04). The use of highly active antiretroviral therapy was associated with more rapid conversion of smears and cultures and with improved survival.


CONCLUSIONS
HIV-infected patients who received a 6-month rifamycin-based course of tuberculosis treatment or who received intermittent therapy had a higher relapse rate than HIV-infected subjects who received longer therapy or daily therapy, respectively. Standard 6-month therapy may be insufficient to prevent relapse in patients with HIV.
Nahid
Payam
P
University of California, San Francisco, San Francisco General Hospital, 1001 Potrero Avenue, 5k1, San Francisco, CA 94110, USA. pnahid@ucsf.edu
Gonzalez
Leah C
LC
Rudoy
Irina
I
de Jong
Bouke C
BC
Unger
Alon
A
Kawamura
L Masae
LM
Osmond
Dennis H
DH
Hopewell
Philip C
PC
Daley
Charles L
CL
D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use; D000904:Antibiotics, Antitubercular / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy / Q000401:mortality; D006801:Humans; D008297:Male; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification; D012008:Recurrence; D012189:Retrospective Studies; D017828:Rifabutin / Q000627:therapeutic use*; D012495:San Francisco / Q000453:epidemiology; D015996:Survival Rate; D016896:Treatment Outcome; D014376:Tuberculosis / Q000150:complications / Q000188:drug therapy* / Q000401:mortality
D044966:Anti-Retroviral Agents; D000904:Antibiotics, Antitubercular; D017828:Rifabutin