Important note: Information in this article was accurate in November 2001. The state of the art may have changed since the publication date.AIDSWEEKLY Plus; Monday, November 12, 2001
Michael Greer, Senior Medical Writer
NewsRx -- Patients coinfected with tuberculosis and HIV have a heightened risk of tuberculosis relapse, researchers in the United States warn.
"The optimal duration of tuberculosis treatment for persons infected with human immunodeficiency virus (HIV) has been debated," according to Cynthia R. Driver and colleagues working with the New York City Department of Health Tuberculosis Control Program.
Coinfected patients should receive longer treatment regimens or be checked regularly for tuberculosis recurrence, they say.
Driver and coworkers evaluated therapy outcomes in 4571 patients who were treated with the standard four-drug regimen of isoniazid, rifampin, pyrazinamide and ethambutol (or streptomycin) for at least 24 weeks. None of the patients carried drug-resistant tuberculosis.
Patients with HIV were significantly more likely to test positive for tuberculosis after treatment, study data showed. The rate of recurrence (positive culture less than 30 days after the last day of treatment) and relapse (positive culture more than 30 days after treatment) was 2.0 per 100 person-years in coinfected patients, the researchers said, compared with a rate of 0.4 per 100 person-years in HIV negative tuberculosis patients.
A treatment regimen lasting 36 weeks or fewer was associated with a significantly higher recurrence risk in HIV patients (Relapse in persons treated for drug-susceptible tuberculosis in a population with high coinfection with human immunodeficiency virus in New York City, Clin Infect Dis 2001 Nov 15;33(10):1762-9).
"Clinicians should be aware of the possibility of recurrence of tuberculosis 6-9 months after the start of treatment," Driver and coauthors recommended. "Sputum evaluation to ensure cure or assessment 3 months after completion of treatment should be performed among persons infected with HIV who receive the shorter regimen."
The corresponding author for this report is Cynthia R. Driver, Tuberculosis Control Program, New York City Department of Health, 125 Worth St., New York, NY 10013, USA.
Key points reported in this study include:
This article was prepared by AIDS Weekly editors from staff and other reports.
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