title: Treatment outcomes of patients with HIV and tuberculosis.
abstract: 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.
authors.affiliation: University of California, San Francisco, San Francisco General Hospital, 1001 Potrero Avenue, 5k1, San Francisco, CA 94110, USA. pnahid@ucsf.edu
authors.forename: Payam
authors.initials: P
authors.lastname: Nahid
authors.forename: Leah C
authors.initials: LC
authors.lastname: Gonzalez
authors.forename: Irina
authors.initials: I
authors.lastname: Rudoy
authors.forename: Bouke C
authors.initials: BC
authors.lastname: de Jong
authors.forename: Alon
authors.initials: A
authors.lastname: Unger
authors.forename: L Masae
authors.initials: LM
authors.lastname: Kawamura
authors.forename: Dennis H
authors.initials: DH
authors.lastname: Osmond
authors.forename: Philip C
authors.initials: PC
authors.lastname: Hopewell
authors.forename: Charles L
authors.initials: CL
authors.lastname: Daley
mesh_terms: 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
chemical_list: D044966:Anti-Retroviral Agents; D000904:Antibiotics, Antitubercular; D017828:Rifabutin