Published ahead of print on February 8, 2007, doi:10.1164/rccm.200509-1529OC Am. J. Respir. Crit. Care Med., Volume 175, Number 11, June 2007, 1199-1206 A more recent version of this article appeared on June 1, 2007
Submitted on September 28, 2005 Treatment Outcomes of Patients with HIV and TuberculosisPayam Nahid1*,1 Department of Pulmonary and Critical Care Medicine, University of California, San Francisco, San Francisco, CA, USA; Department of Public Health, The Tuberculosis Control Section, San Francisco, CA, USA, 2 Department of Pulmonary and Critical Care Medicine, University of California, San Francisco, San Francisco, CA, USA, 3 Stanford University, Stanford, CA, USA, 4 Department of Public Health, The Tuberculosis Control Section, San Francisco, CA, USA; Department of Pulmonary and Critical Care Medicine, University of California, San Francisco, San Francisco, CA, USA, 5 Division of Mycobacterial and Respiratory Infections, National Jewish Medical and Research Center, Denver, CO, USA * To whom correspondence should be addressed. E-mail: pnahid{at}ucsf.edu.
Rationale: The optimal length of tuberculosis treatment in patients co-infected with human immunodeficiency virus (HIV) is unknown. Objectives: To evaluate treatment outcomes for HIV-infected patients stratified by duration of rifamycin-based tuberculosis therapy. Methods: We retrospectively reviewed data on all patients with tuberculosis reported to the San Francisco Tuberculosis Control Program from 1990-2001. Patients were followed for up to 12 months after treatment completion. Measurements and Main Results: Of 700 patients, 264 (38%) were HIV infected, 315 (45%) were not infected, and 121 (17%) were not tested. For a variety of reasons, mean duration of treatment was extended to 10.2 months for HIV infected versus 8.4 months for uninfected/unknown (p<0.001). Seventeen percent of the HIV-infected and 37% of the HIV uninfected/unknown patients received 6-month "short-course" rifamycin-based therapy. The relapse rate among HIV-infected was 9.3 per 100 person-years versus 1.0 in HIV-uninfected/unknown (p<0.001). HIV-infected individuals who received a standard 6-month rifamycin-based regimen were more likely to relapse than those treated longer (adjusted hazard ratio [AHR], 4.33, p=0.02). HIVinfected individuals who received intermittent therapy were also more likely to relapse than those treated on daily basis (AHR, 4.12, p=0.04). Use of highly active antiretroviral therapy was associated with more rapid conversion of smears and cultures as well as improved survival. Conclusions: HIV-infected patients who received a 6-month rifamycin-based course of tuberculosis treatment or received intermittent therapy had a higher relapse rate than HIV-infected subjects who received longer therapy or daily therapy, respectively. Standard 6-month therapy may be insufficient to prevent relapse in patients with HIV. Key words: Tuberculosis Pulmonary/epidemiology,HIV/AIDS, Recurrence/Relapse, Rifampin/therapeutic use, HAART
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