© 2008 American Thoracic Society
On Treatment Outcomes of Patients with HIV and TuberculosisTo the Editor:We read with interest the retrospective review by Dr. Nahid and colleagues of tuberculosis (TB) outcomes in San Francisco (1). In their study, they found that HIV-infected subjects had elevated rates of TB relapse; and this was most frequently seen among those receiving anti-TB therapy for only 6 months. As the authors state, these results are in contrast to most published data. We have recently reported retrospective outcome data from a U.K. clinical cohort of over 300 subjects and observed no significant difference in recurrence rates according to HIV status (3% for HIV-infected vs. 1% for uninfected) (2). In both groups, the median duration of anti-TB treatment was 6 months and almost all therapy was self-administered. No difference in outcome was seen in the HIV-infected subjects when analyzed by treatment duration. Our results may reflect demographic differences between the two studies, although we believe that coadministration of highly active antiretroviral therapy (HAART) is more relevant. Of our population, 71% received HAART during treatment for TB compared with 12% in the group reported by Nahid and coworkers. This may go some way to explain our better outcomes—and indeed the current study appears to report no episodes of TB relapse in those receiving HAART. Although the decision to give treatment for 6 or more months appeared to be important to outcome, no data were shown to explain how such an important decision was reached (1). Grouping of subjects according to length of treatment did not appear to reveal differences in disease extent or initial response to treatment, which have been suggested as reasons for treatment prolongation (3). It is intriguing to note that the 6-month treatment group had a significantly greater number of opportunistic infections (OIs) pre-TB than those who received therapy for longer than 6 months. The presence of current or previous OIs is likely to have necessitated prescription of other medication with an increased likelihood of drug-drug interactions and a greater pill burden. This may have affected adherence. We would be interested to know whether these factors were analyzed in relation to relapse.
Royal Free and University College Medical School FOOTNOTES Conflict of Interest Statement: None of the authors has a financial relationship with a commercial entity that has an interest in the subject of this manuscript. REFERENCES
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