Miliary tuberculosis in human immunodeficiency virus infected patients not on antiretroviral therapy: clinical profile and response to shortcourse chemotherapy.
BACKGROUND
An increase in tuberculosis (TB) incidence has been associated with human immunodeficiency virus (HIV).


OBJECTIVE
To describe the clinical characteristics and treatment outcome of patients with HIV and miliary TB treated with short-course intermittent chemotherapy in the absence of access to highly active antiretroviral therapy (HAART).


METHODS
Prospective study of HIV infected adults referred to a TB clinic between July 1999 and July 2004.


METHODS
On diagnosis of miliary TB, patients were treated with a standard regimen of two months of isoniazid, rifampicin, ethambutol and pyrazinamide followed by four months of isoniazid and rifampicin (2EHRZ 3 /4RH 3 ) thrice weekly and followed up for 24 months. Patients were reviewed clinically every month and two sputa were collected. Chest radiographs and blood investigations were done at two months, end of treatment and every six months thereafter.


RESULTS
Of 498 patients with HIV and tuberculosis, 31 (6%) were diagnosed as miliary tuberculosis. At diagnosis, sputum smear was positive for acid-fast bacilli (AFB) in 14 patients (45%) and Mycobacterium tuberculosis was isolated in 21 (68%). The mean CD4 cell count was 129 +/- 125 cells/mm3 . Twenty-five patients were declared cured at the end of treatment (81%) while one (3%) died and five (16%) failed. The recurrence rate was 19.4/100 person-years and the median survival was 17 months (95% CI 14 to 20). None of the patients received antiretroviral therapy.


CONCLUSIONS
Miliary TB tends to occur among HIV infected patients with severe immunosuppression. Though the initial response to short-course chemotherapy was encouraging, a high recurrence rate and mortality was observed indicating poor prognosis in HIV.
Swaminathan
S
S
Tuberculosis Research Centre, Chennai, India. doctorsoumya@yahoo.com
Padmapriyadarsini
C
C
Ponnuraja
C
C
Sumathi
C H
CH
Rajasekaran
S
S
Amerandran
V A
VA
Reddy
Mvk
M
Deivanayagam
C N
CN
D000328:Adult; D044966:Anti-Retroviral Agents; D000995:Antitubercular Agents / Q000008:administration & dosage*; D015331:Cohort Studies; D004334:Drug Administration Schedule; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D008297:Male; D012008:Recurrence; D016896:Treatment Outcome; D014391:Tuberculosis, Miliary / Q000150:complications* / Q000188:drug therapy* / Q000401:mortality
D044966:Anti-Retroviral Agents; D000995:Antitubercular Agents