[ThPeB7276] Directly observed therapy (DOT) in patients with tuberculosis and HIV infection

14th International AIDS Conference

Barcelona, Spain — July 7-12, 2002

[TITLE:] Directly observed therapy (DOT) in patients with tuberculosis and HIV infection

[AUTHOR(S):] A. Horta, M. Terceiro, J. Méndez, O. Vasconcelos, M. Freitas, R. Sarmento e Castro¹, O. Fortes, C. Recalde²

Int Conf AIDS. 2002 Jul 7-12;14:Abstract No. ThPeB7276

BACKGROUND: HIV-infected IV drug users (IVDUs) are frequently noncompliant to treatment. In a previous group of IVDUs we registered a 35,7% compliance to anti-tuberculous therapy. Morbidity, mortality (40% in 12 months) and Mycobacterium tuberculosis (Mt) drug multiresistance (18%) were very high. In a prospective study we tried to compare adherence and results previously obtained to that of a group submitted to DOT with antituberculous drugs and methadone substitution.

METHODS: Between June 1998 and January 2002, 117 HIV-infected IVDUs diagnosed with tuberculosis (TB) were recruited to take daily antituberculous drugs and methadone under DOT, for a period of nine to twelve months.

RESULTS: Ages ranged from 18 to 50 years. One hundred and three patients (pts) (88.1%) were male. TB diagnosis was based on the isolation of Mt in culture and/or histologic criteria in 101 (86.3%) and on clinical criteria in the other 16 pts (13.7%). Therapy began with isoniazid, rifampin or rifabutin, ethambutol and pyrazinamide in 104 pts (88,9%). Multiresistant Mt was registered in four pts (7%). Side effects were observed in 27 pts (23,1%). Mean CD4 cell count and viral load were at the begining 108,5/mm³ and 582100 copies RNA/mm³ respectively. At the end, these values were 193,6/mm³ and 80141 c/mm³, with 17 pts (14,5%) supressed.

Sixty-nine pts (59%) completed treatment, 18 (15.4%) are still under therapy, seven (6%) withdrew and 23 (19,6%) died while in treatment. TB was the cause of death in only ten of these pts.

Compliance was observed in 103 pts (88%). Seven pts (6%) had an irregular adherence and the remaining withdrew from treatment.

CONCLUSIONS: A once daily antituberculous drugs and methadone regimen under DOT seems to improve compliance and subsequently morbidity and mortality in HIV infected IVDUs.

Presenting author: Ana Horta

1Hospital Joaquim Urbano, Rua Sol Poente, 656, Hab. S, 4450-794 Leça da Palmeira - Portugal, Portugal.

2Drug Users Attendance Centers, Porto, Portugal.

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