title: Achieving international targets for tuberculosis treatment success among HIV-positive patients in New York City.
abstract: OBJECTIVE
  To review outcomes of human immunodeficiency virus (HIV) positive tuberculosis (TB) patients in New York City (NYC) to determine if the World Health Organization treatment success target of 85% was met in a setting with ready access to treatment for HIV and TB.
  
  
  METHODS
  Retrospective review of new TB patients diagnosed from 1995 to 2004, excluding patients with rifampin (RMP) resistance.
  
  
  RESULTS
  Of 9198 eligible TB patients, 83% had achieved treatment success, 8% died during treatment, 4% failed, 3% defaulted and 2% were transferred from NYC. Among 6374 HIV-negative individuals, treatment success was consistently over 85%; 5% died during treatment. Among 2824 HIV-positive individuals, treatment success was 72% overall and 66% in sputum acid-fast bacilli smear-positive patients. Mortality among the HIV-positive decreased from 26% in 1995 to 14% in 2004. HIV-positive patients achieved higher treatment success if 1) they received treatment by directly observed therapy (DOT) (82% vs. 74%, OR(adj) = 1.80, 95%CI 1.44-2.26), or 2) were administered rifabutin (RFB) in the regimen, a proxy for receiving antiretroviral therapy (ART) (84% vs. 78%, OR(adj) = 1.49, 95%CI 1.20-1.85). Treatment success of 85% was achieved in HIV-positive patients who received RFB and DOT.
  
  
  CONCLUSIONS
  High mortality precluded achieving 85% treatment success among HIV-positive TB patients. DOT and ART remain essential for improving success among co-infected patients everywhere.
authors.affiliation: New York City Department of Health and Mental Hygiene, New York, New York 10007, USA. lking@health.nyc.gov
authors.forename: L
authors.initials: L
authors.lastname: King
authors.forename: S S
authors.initials: SS
authors.lastname: Munsiff
authors.forename: S D
authors.initials: SD
authors.lastname: Ahuja
mesh_terms: D000328:Adult; D000368:Aged; D019380:Anti-HIV Agents / Q000627:therapeutic use; D000995:Antitubercular Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D023801:Directly Observed Therapy / Q000379:methods; D005260:Female; D006679:HIV Seropositivity / Q000150:complications* / Q000188:drug therapy / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009519:New York City / Q000453:epidemiology; D012189:Retrospective Studies; D017828:Rifabutin / Q000008:administration & dosage / Q000627:therapeutic use; D013183:Sputum / Q000382:microbiology; D016896:Treatment Outcome; D014376:Tuberculosis / Q000150:complications / Q000188:drug therapy* / Q000401:mortality; D014944:World Health Organization; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents; D000995:Antitubercular Agents; D017828:Rifabutin