Am. J. Respir. Crit. Care Med., Vol 150, No. 6, 12 1994, 1499-1502.
A prospective evaluation of antituberculosis therapy in patients with human immunodeficiency virus infection
BE Jones, M Otaya, D Antoniskis, S Sian, F Wang, A Mercado, PT Davidson and PF Barnes
Department of Medicine, University of Southern California School of Medicine, Los Angeles 90033.
The purpose of this study was to determine the efficacy and toxicity of a
standard antituberculosis regimen in patients with human immunodeficiency
virus (HIV) infection. We prospectively evaluated 89 patients with
tuberculosis and HIV infection at an urban medical center. Eighty-two
patients received isoniazid, rifampin, and pyrazinamide, with or without
ethambutol, for 2 mo, followed by isoniazid and rifampin for 7 mo. Seven
patients received other regimens because of drug resistance or intolerance.
Therapy was self- administered in 57 patients and directly observed in 32
cases. All patients showed rapid clinical improvement during the first
month of therapy, and sputum cultures reverted to negative after 3 mo in 52
of 54 patients from whom specimens were obtained. Adverse reactions to
isoniazid or rifampin prompted alterations in antituberculosis regimens in
five patients (6%). Forty patients (45%) died during follow-up, and
tuberculosis was a potential contributory cause of death in three cases.
Treatment failure occurred in five patients (6%), four of whom were
noncompliant with therapy. The fifty patient had an isoniazid- resistant
organism. No relapses occurred in 916 patient-months of follow-up
posttreatment. We thus conclude that the 9-mo regimen used for treatment of
drug-susceptible tuberculosis in HIV-infected patients is effective and
well tolerated.
