A prospective evaluation of antituberculosis therapy in patients with human immunodeficiency virus infection

Am J Respir Crit Care Med. 1994 Dec;150(6 Pt 1):1499-502. doi: 10.1164/ajrccm.150.6.7952606.

Abstract

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.

Publication types

  • Clinical Trial
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • AIDS-Related Opportunistic Infections / drug therapy*
  • AIDS-Related Opportunistic Infections / microbiology
  • AIDS-Related Opportunistic Infections / mortality
  • Adult
  • Antitubercular Agents / adverse effects
  • Antitubercular Agents / therapeutic use*
  • Drug Therapy, Combination
  • Ethambutol / administration & dosage
  • Ethambutol / adverse effects
  • Female
  • HIV-1*
  • Humans
  • Isoniazid / administration & dosage
  • Isoniazid / adverse effects
  • Los Angeles / epidemiology
  • Male
  • Mycobacterium tuberculosis / isolation & purification
  • Patient Compliance
  • Prospective Studies
  • Pyrazinamide / administration & dosage
  • Pyrazinamide / adverse effects
  • Remission Induction
  • Rifampin / administration & dosage
  • Rifampin / adverse effects
  • Time Factors
  • Treatment Outcome
  • Tuberculosis, Pulmonary / drug therapy*
  • Tuberculosis, Pulmonary / microbiology
  • Tuberculosis, Pulmonary / mortality

Substances

  • Antitubercular Agents
  • Pyrazinamide
  • Ethambutol
  • Isoniazid
  • Rifampin