Effectiveness of supervised, intermittent therapy for tuberculosis in HIV-infected patients

Objective: To evaluate the effectiveness of supervised therapy for tuberculosis (TB) in patients with HIV infection. Design: Retrospective, chart review. Patients: Patients with TB and HIV infection. Setting: Urban, public TB clinic. Main measures and results: A total of 107 patients with TB and HIV infection were studied. Most were men (78%), African American (91%), uninsured or on Medicaid (88%), and 67% were injecting drug users. TB was diagnosed before AIDS in 31% of subjects, at the time of AIDS in 32%, and after AIDS in 37%. Clinical features varied by stage of HIV disease. Sixteen patients received no therapy and died before TB was diagnosed, 10 died during the first 8 weeks of treatment. Seventy-eight patients received >8 weeks therapy, of whom 48 (62%) were given directly observed therapy twice weekly and 30 (38%) received self-administered daily therapy. Patients who received directly observed therapy were more likely to complete 6 months of therapy (96 versus 76%, P = 0.02) and more likely to survive after therapy ended (85 versus 57%, P = 0.01). By logistic regression, directly observed therapy, AIDS diagnosed before TB, and age were significantly associated with survival outcome. Conclusion: Directly observed therapy for TB in patients with HIV infection is highly effective and associated with better adherence to therapy and survival.