Rifamycin-resistant Mycobacterium tuberculosis in the highly active antiretroviral therapy era: a report of 3 relapses with acquired rifampin resistance following alternate-day rifabutin and boosted protease inhibitor therapy.
Rifamycin-resistant Mycobacterium tuberculosis infection (i.e., by a strain of M. tuberculosis that is only resistant to rifamycins) occurs disproportionately among patients infected with the human immunodeficiency virus (HIV) who have a low CD4 cell count. We observed 3 genetically confirmed cases of relapse with rifamycin-resistant M. tuberculosis infection following concurrent treatment with rifabutin (dosage, 150 mg every other day) and a ritonavir-boosted HIV protease inhibitor during a prior episode of drug-susceptible tuberculosis. Higher doses of rifabutin and a ritonavir-boosted HIV protease inhibitor as treatment for tuberculosis should be studied further.
Jenny-Avital
Elizabeth R
ER
Jacobi Medical Center, Administration for Children's Services Clinic, Bronx, New York 10461, USA. jennyavita@earthlink.net
Joseph
Kareen
K
D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active; D000995:Antitubercular Agents / Q000494:pharmacology* / Q000627:therapeutic use; D024881:Drug Resistance, Bacterial; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy; D017320:HIV Protease Inhibitors / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000187:drug effects* / Q000302:isolation & purification; D012008:Recurrence; D017828:Rifabutin / Q000494:pharmacology* / Q000627:therapeutic use; D019438:Ritonavir / Q000627:therapeutic use; D016896:Treatment Outcome; D014376:Tuberculosis / Q000382:microbiology*
D019380:Anti-HIV Agents; D000995:Antitubercular Agents; D017320:HIV Protease Inhibitors; D017828:Rifabutin; D019438:Ritonavir