2nd National Conference Human Retroviruses and Related Infections Washington, DC - January 29 - February 2, 1995

Natl Conf Hum Retrovir Relat Infect 1995 Jan 29-Feb 2;2: (abstract no. 4)

Salomon N, Perlman DC
Beth Israel Medical Center, New York, NY

Outbreaks of multi-drug-resistant (MDR) tuberculosis (TB) with high early mortality (median survival, 2.1 months) and virtually 100% bacteriologic failure have been recently described in HIV+ persons. The contributions of immunosuppression, nonadherence and delayed treatment (RX) to these outcomes are uncertain. We report early outcomes among HIV+ persons with MDR-TB receiving directly observed therapy (DOT). Cohort was actively recruited using daily review of all new smear or culture (CLT) positive [+] TB isolates since 9/01/93. DOT conducted in our AIDS clinic. Susceptibility by Bactec and solid media at NYCDOH. From 9/93-7/94, 10 HIV+ MDR-TB cases (i.e., isolate resistant to ≥ INH and RIF) were identified. Median CD4+ count: 114/mm³. Sites of TB: 9 pulmonary (PTB), 1 extrapulmonary (EPTB). The 10 pts were initially treated for a median of 49 days (d) (range, 5-75) with one (2 pts) or no drugs (6 pts) to which their isolate was susceptible. 1 PTB died 5 d after RX onset. The remaining 9 (90%) survived and received, 1 after MDR was known, a mean of 4.2 active drugs. All 9 pts are alive as of 07/31/94 [median survival from MDR-TB DX, 10.2 months (mos); range, 2,4-19]. All 9 have been discharged. The one with EPTB elected to receive self-administered RX. The 8 PTB cases were placed on DOT 5 days/week. All 8 PTB cases became CLT [-]. Seven became CLT [-] with medical Rx alone a median of 2.1 mos (range, 0.8-6.3) after the onset of DOT; the other underwent right upper lobectomy because of persistent CLT [+] after 8.5 mos of DOT and then became CLT [-]. All have remained CLT [-] after 15.9 person-mos of bacteriologic followup. Bacteriologic response and survival of HIV+ person with MDR- TB can exceed that previously reported when treated with effective agents with adherence assured by DOT.

Keywords: Acquired Immunodeficiency Syndrome, HIV Infections, HIV Seropositivity, Humans, Tuberculosis, Multidrug-Resistant Tuberculosis

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1995-01-29
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