Document Detail


Long term follow up of HIV-infected patients with tuberculosis treated with 6-month intermittent short course chemotherapy.
MedLine Citation:
PMID:  18472696     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Tuberculosis occurs in 60%-70% of HIV-positive persons in India. The outcome of HIV-positive patients treated with 6-month intermittent short course antituberculosis regimens in India is not well described. METHODS: This was a prospective observational feasibility study of 71 patients with HIV and tuberculosis who were treated with category I regimen of the Revised National Tuberculosis Control Programme (ethambutol, isoniazid, rifampicin and pyrazinamide thrice weekly for the initial 2 months followed by rifampicin and isoniazid thrice weekly for the next 4 months). Sputum was examined by smear and culture for Mycobacterium tuberculosis every month up to 24 months. Chest X-ray, CD4 cell count and viral load were done prior to and at the end of treatment. None of the patients received antiretroviral therapy. RESULTS: We present here the treatment response of patients with sputum culture-positive pulmonary tuberculosis to category I regimen. By efficacy analysis, among 43 patients treated with category I regimen, sputum smear conversion was observed in 79% and culture conversion in 82% at the second month. A favourable response was seen in 72% of patients. The mean (SD) CD4% fell from 12.6 (5.9) to 8.9 (4.9) (p < 0.001) with no significant change in mean (SD) CD4 cell count (169 [126] to 174 [158]; ns) at the end of treatment. Viral load change from 1.8 x 10(5) at baseline to 1.3 x 10(5) at the end of treatment was not statistically significant. Thirty-one patients, who completed the full course of treatment, were declared cured and were followed up for 24 months. Twelve had recurrent tuberculosis (39%); 16 of 43 (37%) patients had died by the end of 24 months, two-thirds due to causes other than tuberculosis. CONCLUSION: Though the early bacteriological response to intermittent short course antituberculosis regimen was satisfactory, the overall outcome was adversely affected by the high mortality (during and after completion of treatment) and recurrence rate among HIV-infected patients with tuberculosis. Immune status deteriorated in spite of antituberculosis treatment, highlighting the need for antiretroviral treatment in addition to antituberculosis treatment to improve the long term outcome. The results of this pilot study need to be confirmed by larger studies.
Authors:
Soumya Swaminathan; C N Deivanayagam; S Rajasekaran; P Venkatesan; C Padmapriyadarsini; Pradeep A Menon; C Ponnuraja; Meenalochani Dilip
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The National medical journal of India     Volume:  21     ISSN:  0970-258X     ISO Abbreviation:  Natl Med J India     Publication Date:    2008 Jan-Feb
Date Detail:
Created Date:  2008-05-13     Completed Date:  2008-06-04     Revised Date:  2009-07-30    
Medline Journal Info:
Nlm Unique ID:  8809315     Medline TA:  Natl Med J India     Country:  India    
Other Details:
Languages:  eng     Pagination:  3-8     Citation Subset:  IM    
Affiliation:
Tuberculosis Research Centre, Mayor V R Ramanathan Road, Chetput, Chennai 600031, Tamil Nadu, India. doctorsoumya@yahoo.com
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Antitubercular Agents / therapeutic use*
CD4 Lymphocyte Count
Ethambutol / therapeutic use
Feasibility Studies
Female
HIV Infections / complications*,  physiopathology
Humans
India
Isoniazid / therapeutic use
Male
Middle Aged
Mycobacterium tuberculosis
Prospective Studies
Pyrazinamide / therapeutic use
Recurrence
Rifampin / therapeutic use
Treatment Outcome
Tuberculosis / diagnosis,  drug therapy*,  etiology
Chemical
Reg. No./Substance:
0/Antitubercular Agents; 13292-46-1/Rifampin; 54-85-3/Isoniazid; 74-55-5/Ethambutol; 98-96-4/Pyrazinamide

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