HIV This Week

Nahid P, Gonzalez LC, Rudoy I, de Jong BC, Unger A, Kawamura LM, Osmond DH, Hopewell PC, Daley CL. Treatment outcomes of patients with HIV and tuberculosis. Am J Respir Crit Care Med 2007 Feb 8; [Epub ahead of print]

The optimal length of tuberculosis treatment in patients co-infected with human immunodeficiency virus (HIV) is unknown. Nahid and colleagues evaluated the treatment outcomes for HIV-infected patients stratified by duration of rifamycin-based tuberculosis therapy. The authors 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. 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). HIV-infected 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. The authors concluded that 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.

Editors’ note: This study demonstrates the advantages of HIV serostatus knowledge in the context of tuberculosis treatment. Diagnostic testing, under the standard 3Cs conditions (confidentiality, informed consent and counselling), is recommended when a person presents signs or symptoms consistent with HIV-related disease. In the case of tuberculosis, treatment can be tailored to achieve better outcomes in co-infected persons.