Opportunistic Infections & Other Complications: Tuberculosis


Opportunistic Infections & Other Complications: Tuberculosis

Seattle Treatment Education Project (STEP) Perspective, Vol. 5, No. 2 - July 1993 * 127 Broadway E. Ste 200 Seattle, WA 98102
Laury McKean, RN

The incidence of tuberculosis in HIV positive individuals is 41 times higher than the general population. With this increased risk and the increasing prevalence of tb, the importance of aggressive prevention measures can not be stressed enough. Because anergy increases as the CD4 count declines, PPD testing early in the course of HIV is essential. Control antigens should always be used to detect anergy. Some researchers are now advocating the use of isoniazid (INH) prophylaxis in anergic individuals with low CD4 counts, especially in areas where the prevalence of tb is high such as New York and Miami (PO-B07-1190, PO-B07-1153, PO-B07- 1114). Prophylaxis with 300 mg of INH for six months significantly decreases the risk in high-risk individuals. However, the incidence increases postprophylaxis. Therefore, reprophylaxis after 24 months should be considered (PO-B07-1114).

One study suggested that AZT may have a protective effect against tb. Of 133 individuals who received AZT, 14 acquired tb. This was compared with 170 individuals who were not receiving AZT, 72 of whom acquired tb. However, this was only a retrospective chart review and other factors could have influenced the outcome. Large, prospective trials are needed to confirm this data (PO-B07-1118).

Unfortunately, the outlook is still bleak concerning treatments for multi- drug resistant tuberculosis (MDRTB). There are some six and seven drug regimens that show potential for good efficacy. The six drug regimen includes INH, rifampin, ethambutol, and pyrazinamide, plus two of either ethionamide, ciprofloxacin, cycloserine, and capreomycin. The seven drug regimen includes the six drug regimen plus one additional drug from the last group mentioned above (WS-B09-5). However, there is good probability that many individuals will not be able to tolerate such a regimen.
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Always watch for outdated information. This article first appeard in 1993. This material is designed to support, not replace, the relationship that exists between you and your doctor.

Copyright © 1993 - Seattle Treatment Education Project (STEP) - All rights reserved. Noncommercial reproduction is encouraged. STEP is published four times a year by the Seattle Treatment Education Project, 127 Broadway East, 3rd Floor, Seattle, WA 98102.    Email: step100@aol.com  STEP web page

This information is designed to support, not replace, the relationship that exists between you and your doctor.
©1993. AEGIS.