Important note: Information in this article was accurate in August 2005. The state of the art may have changed since the publication date.
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AIDSWEEKLY Plus; Monday, August 15, 2005
Staff Medical Writers
According to recent research from the United States, "The relationship between rifamycin use and either relapse or treatment failure with acquired rifampin resistance (ARR) among human immunodeficiency virus (HIV)-infected patients with tuberculosis (TB) is not well understood.
"We conducted a retrospective cohort study of HIV-infected and HIV-uninfected persons with rifampin-susceptible TB, (1) to compare relapse rates, ARR, and treatment failure, according to HIV serostatus; and (2) to examine whether and how use of rifamycin was associated with clinical outcomes of interest among HIV-infected patients with TB."
"HIV-infected patients were more likely to have ARR than were HIV-uninfected patients (0.9 vs. 0.1%; p=0.007), and the association remained significant in multivariate analysis (adjusted odds ratio [OR], 5.5; 95% confidence interval [CI], 1.4-21.5)," wrote the authors," reported J.H. Li and coworkers at the New York City Department of Health and Mental Hygiene.
"Among HIV-infected patients with TB," the authors continued, "none of 57 patients treated with rifabutin-based regimens alone had ARR, and only 1 of 395 patients treated with rifabutin given in combination with a rifampin-based regimen had ARR, whereas 6 of 355 patients treated with a rifampin-based regimen alone had relapse and ARR."
"HIV-infected patients treated with rifampin-based regimens alone had a higher risk for relapse and development of rifampin resistance if intermittent dosing of rifampin was started during the intensive phase of treatment, compared with patients who did not receive intermittent dosing (hazard ratio [HR] for relapse, 6.7 [95% CI, 1.1-40.1]; HR for ARR, 6.4 [95% CI, 1.1-38.4]).
"This association remained when confined to patients with a CD4+ T lymphocyte count of <100 lymphocytes/mm3. Intermittent dosing started only after the intensive phase of treatment did not increase the risks of relapse and ARR among HIV-infected patients with TB," said Li.
Researchers concluded, "The risk for ARR among HIV-infected persons with TB did not depend on the rifamycin used but, rather, on the rifampin dosing schedule in the intensive phase of treatment."
Li and colleagues published their study in Clinical Infectious Diseases (Relapse and acquired rifampin resistance in HIV-infected patients with tuberculosis treated with rifampin- or rifabutin-based regimens in New York City, 1997-2000. Clin Infect Dis. 2005 Jul 1;41(1):83-91.
For additional information, contact J.H. Li, New York City Dept. Health & Mental Hyg, Bur TB Control, 225 Broadway, 22nd Fl, CN-72B, New York City, NY 10007, USA.
Publisher contact information for the journal Clinical Infectious Diseases is: University Chicago Press, 1427 E 60th St., Chicago, IL 60637-2954, USA.
Keywords: New York, New York, United States, HIV/AIDS, Rifampin, Tuberculosis, Drug Resistance, Dosing Schedule:89
This article was prepared by AIDS Weekly editors from staff and other reports.
Reference
Li J, Munsiff SS, Driver CR, et al., Relapse and acquired rifampin resistance in HIV-infected patients with tuberculosis treated with rifampin- or rifabutin-based regimens in New York City, 1997-2000., Clin Infect Dis. 2005 Jul 1;41(1):83-91.
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