United Press International - Friday, 27 October 2000
Peggy Peck in Cleveland, Ohio

That's the finding from a new study, published in the current issue of the British journal Lancet, of 142 patients who were co-infected with HIV-1 and TB.

The researchers report that HIV-1 infected patients who followed up standard TB treatment with a year-long medication, the anti-tuberculosis drug isoniazid, had a significant decrease in the recurrence rate for TB.

Among TB patients who were HIV-1 negative, the year of preventive treatment had no effect, report the American and Haitian investigators.

Study author Dr. Jean William Pape of Cornell University Medical College writes the year-long prophylaxis "should be considered for HIV-1 positive individuals with a history of HIV-1-related symptoms at the time of tuberculosis diagnosis."

He said, however, that even though the preventive treatment reduces the likelihood of another bout of TB, isoniazid did not improve survival.

The dual infection -- TB and HIV -- is "associated with advanced-stage HIV-1 disease," Pape writes. These patients are "also the ones most likely to die from other AIDS illnesses."

Pape and his colleagues report that the recurrence rate for TB fell to 1.4 per 100 person-years, compared to a rate of 7.8 per 100 person years for HIV-1 patients who took a placebo for the year following initial TB treatment.

Working with residents of Haiti, the researchers selected 142 HIV-1 patients who successfully completed a 6-month regimen of TB treatment. The group was randomly split in two, as receiving either one year of treatment with isoniazid or placebo, or sugar pill. Ninety-one former TB patients who were HIV-negative were also randomized to one year of active treatment or placebo.

Dr. Giorgio Roscigno, acting CEO of a non-profit group whose focus is development of new drugs to treat TB in developing nations, said the study illustrates the difficulty of completely eradicating the micro-bacilli that carry TB in persons whose immune system is compromised by HIV-1 infection.

In an interview with United Press International, Roscigno said the new study makes a compelling case for continuing the use of anti-TB drugs such as isoniazid for at least a year after "TB cultures come back negative."

Roscigno, who was a researcher on a similar study of HIV and tuberculosis in Zaire, said he thinks that Pape's team is "reporting a recurrence or relapse of the original infection. It is, however, difficult to determine this because the researchers did not do molecular analysis to identify the original bacilli and then follow up to type the bacilli in the 'recurrent' cases."

Thus the lack of this "molecular fingerprint" means the recurrent TB infection could be "either relapse or re-infection with a new strain," he summarized.

"But irrespective of the source of the infection, the important message is that prophylaxis can reduce recurrence," said Roscigno.

He told UPI that HIV-1 infected persons have a very high risk of acquiring active tuberculosis because worldwide the "exposure to tuberculosis stands at 1.3 billion." Most people, however, never get active disease because "they have competent immune systems to ward it off," he said.

Roscigno's group, the Global Alliance for TB Drug Development -- which he describes as a non-profit international consortium with representatives of the World Health Organization, the Centers for Disease Control, infectious disease researchers and pharmaceutical companies -- has as its goal the development of a TB drug that "can eradicate TB within two months."

He said such a powerful new drug could "accomplish prophylaxis with just a week-long treatment."

The group was launched two weeks ago at a ceremony in Bangkok, Roscigno said.

Also in this week's issue of The Lancet, Dr. E. Frances Bowen and a team of researchers from St. Georges Hospital, London report that a sampling of tuberculosis clinics in England suggests that as many as 17 to 20 percent of persons with tuberculosis may be co-infected with HIV-1.

Bowen concludes that persons receiving treatment for tuberculosis should be tested for HIV-1.
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