Am. J. Respir. Crit. Care Med., Vol 152, No. 3, Sep 1995, 1067-1071.
Evolution of rifampin resistance in human immunodeficiency virus- associated tuberculosis
CM Nolan, DL Williams, MD Cave, KD Eisenach, H el-Hajj, TM Hooton, RL Thompson and SV Goldberg
Seattle-King County Department of Public Health, University of Washington, Seattle 98104, USA.
Acquired rifampin resistance without preexisting isoniazid resistance is
highly unusual in patients with tuberculosis. The purpose of this report is
to describe and characterize that unusual pattern of acquired drug
resistance in three patients with human immunodeficiency virus (HIV)
infection. The patients originally had Mycobacterium tuberculosis strains
that were susceptible to isoniazid and rifampin. During treatment in two
patients and after completion of therapy in the remaining one, each patient
developed active, rifampin-resistant, isoniazid-susceptible tuberculosis.
One patient subsequently developed isoniazid resistance also. Studies on
patients' M. tuberculosis isolates using IS6110 restriction fragment length
polymorphism typing and rpoB gene sequencing indicated that rifampin
resistance in each patient arose during therapy by an rpoB gene mutation in
the original M. tuberculosis isolate. Detection of this unusual
drug-resistance phenotype in three patients with HIV infection suggests
that acquired rifampin resistance is somehow associated with co-infection
due to HIV and tuberculosis.
