Treatment of tuberculosis in patients with advanced human immunodeficiency virus infection

Peter M. Small, Gisela F. Schecter, Philip C. Goodman, Merle A. Sande, Richard E Chaisson, Philip C. Hopewell

Research output: Contribution to journalArticle

Abstract

Background and Methods. Infection with the human immunodeficiency virus (HIV) increases the risk of tuberculosis and may interfere with the effectiveness of antituberculosis chemotherapy. To examine the outomes in patients with both diagnoses, we conducted a retrospective study of all 132 patients listed in both ie acquired immunodeficiency syndrome (AIDS) and tuberculosis case registries in San Francisco from 1981 trough 1988. Results. At the time of the diagnosis of tuberculosis, 78 patients (59 percent) did not yet have a diagnosis of AIDS, 18 patients (14 percent) were given a concomitant dignosis of AIDS (as determined by the presence of an AIDS-defining disease other than tuberculosis), and the remaining 36 patients (27 percent) already had AIDS. The manifestations of tuberculosis were entirely pulmonary in J patients (38 percent), entirely extrapulmonary in 40 patients (30 percent), and both pulmonary and extrapulnonary in 42 patients (32 percent). The treatment regimens were as follows: isoniazid and rifampin supplemented by ethambutol for the first two months, 52 patients; isoniazid and rifampin supplemented by pyrazinamide and ethambutol for the first two months, 39 patients; isoniazid and rifampin, 13 patients; isoniazid and rifampin supplemented by pyrazinamide for the first two months, 4 patients; and other drug regimens, 17 patients. The intended duration of treatment for patients whose regimen included pyrazinamide was six months, and for patients who did not receive pyrazinamide, nine months. Seven patients received no treatment because tuberculosis was first diagnosed after death. Sputum samples became clear of acidfast organisms after a median of 10 weeks of therapy. Abnormalities on all chest radiographs taken after three months of treatment were stable or improved except for those of patients who had new nontuberculous infections. The only treatment failure occurred in a man infected with multiple drug-resistant organisms who did not comply with therapy. Adverse drug reactions occurred in 23 patients (18 percent). For all 125 treated patients, median survival was 16 months from the diagnosis of tuberculosis. Tuberculosis was a major contributor to death in 5 of the 7 untreated patients and 8 of the 125 treated patients. Three of 58 patients who completed therapy had a relapse (5 percent); compliance was poor in all 3. Conclusions. Tuberculosis causes substantial mortality in patients with advanced HIV infection. In patients who comply with the regimen, conventional therapy results in rapid sterilization of sputum, radiographic improvement, and low rates of relapse.

Original languageEnglish (US)
Pages (from-to)289-294
Number of pages6
JournalNew England Journal of Medicine
Volume324
Issue number5
StatePublished - Jan 31 1991
Externally publishedYes

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Virus Diseases
Tuberculosis
HIV
Therapeutics
Pyrazinamide
Isoniazid
Rifampin
Acquired Immunodeficiency Syndrome
Ethambutol
Sputum
Recurrence

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Small, P. M., Schecter, G. F., Goodman, P. C., Sande, M. A., Chaisson, R. E., & Hopewell, P. C. (1991). Treatment of tuberculosis in patients with advanced human immunodeficiency virus infection. New England Journal of Medicine, 324(5), 289-294.

Treatment of tuberculosis in patients with advanced human immunodeficiency virus infection. / Small, Peter M.; Schecter, Gisela F.; Goodman, Philip C.; Sande, Merle A.; Chaisson, Richard E; Hopewell, Philip C.

In: New England Journal of Medicine, Vol. 324, No. 5, 31.01.1991, p. 289-294.

Research output: Contribution to journalArticle

Small, PM, Schecter, GF, Goodman, PC, Sande, MA, Chaisson, RE & Hopewell, PC 1991, 'Treatment of tuberculosis in patients with advanced human immunodeficiency virus infection', New England Journal of Medicine, vol. 324, no. 5, pp. 289-294.
Small, Peter M. ; Schecter, Gisela F. ; Goodman, Philip C. ; Sande, Merle A. ; Chaisson, Richard E ; Hopewell, Philip C. / Treatment of tuberculosis in patients with advanced human immunodeficiency virus infection. In: New England Journal of Medicine. 1991 ; Vol. 324, No. 5. pp. 289-294.
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N2 - Background and Methods. Infection with the human immunodeficiency virus (HIV) increases the risk of tuberculosis and may interfere with the effectiveness of antituberculosis chemotherapy. To examine the outomes in patients with both diagnoses, we conducted a retrospective study of all 132 patients listed in both ie acquired immunodeficiency syndrome (AIDS) and tuberculosis case registries in San Francisco from 1981 trough 1988. Results. At the time of the diagnosis of tuberculosis, 78 patients (59 percent) did not yet have a diagnosis of AIDS, 18 patients (14 percent) were given a concomitant dignosis of AIDS (as determined by the presence of an AIDS-defining disease other than tuberculosis), and the remaining 36 patients (27 percent) already had AIDS. The manifestations of tuberculosis were entirely pulmonary in J patients (38 percent), entirely extrapulmonary in 40 patients (30 percent), and both pulmonary and extrapulnonary in 42 patients (32 percent). The treatment regimens were as follows: isoniazid and rifampin supplemented by ethambutol for the first two months, 52 patients; isoniazid and rifampin supplemented by pyrazinamide and ethambutol for the first two months, 39 patients; isoniazid and rifampin, 13 patients; isoniazid and rifampin supplemented by pyrazinamide for the first two months, 4 patients; and other drug regimens, 17 patients. The intended duration of treatment for patients whose regimen included pyrazinamide was six months, and for patients who did not receive pyrazinamide, nine months. Seven patients received no treatment because tuberculosis was first diagnosed after death. Sputum samples became clear of acidfast organisms after a median of 10 weeks of therapy. Abnormalities on all chest radiographs taken after three months of treatment were stable or improved except for those of patients who had new nontuberculous infections. The only treatment failure occurred in a man infected with multiple drug-resistant organisms who did not comply with therapy. Adverse drug reactions occurred in 23 patients (18 percent). For all 125 treated patients, median survival was 16 months from the diagnosis of tuberculosis. Tuberculosis was a major contributor to death in 5 of the 7 untreated patients and 8 of the 125 treated patients. Three of 58 patients who completed therapy had a relapse (5 percent); compliance was poor in all 3. Conclusions. Tuberculosis causes substantial mortality in patients with advanced HIV infection. In patients who comply with the regimen, conventional therapy results in rapid sterilization of sputum, radiographic improvement, and low rates of relapse.

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