Influence of treatment and immunological recovery on tuberculosis relapses in HIV-infected patients

• Published in: The international journal of tuberculosis and lung disease Vol. 9; no. 12; pp. 1385 - 1390
• Main Authors: LOPEZ-CORTES, L. F, MANN-NIEBLA, A, LOPEZ-CORTES, L. E, VILLANEGO, I, RODRIGUEZ-DIEZ, M, PASCUAL-CARRASCO, R
• Format: Journal Article
• Language: English
• Published: Paris, France IUATLD 01.12.2005; Union internationale contre la tuberculose et les maladies respiratoires
• Subjects: Adult; Antiretroviral Therapy, Highly Active; Antitubercular Agents - administration & dosage; Bacterial diseases; Biological and medical sciences; CD4 Lymphocyte Count; Drug Administration Schedule; Drug Therapy, Combination; Female; Follow-Up Studies; HIV infection; HIV Infections - complications; HIV Infections - drug therapy; HIV Infections - immunology; Human bacterial diseases; Human immunodeficiency virus; Humans; Incidence; Infectious diseases; Male; Medical sciences; Middle Aged; Miscellaneous; Mycobacterium tuberculosis; Patient Compliance; Pneumology; Prevention and actions; Prospective Studies; Public health. Hygiene; Public health. Hygiene-occupational medicine; Recurrence; Respiratory system : syndromes and miscellaneous diseases; Risk Factors; Tuberculosis - complications; Tuberculosis - drug therapy; Tuberculosis - immunology; Tuberculosis and atypical mycobacterial infections; Tuberculosis Relapse; Tuberculosis Treatment; Human; Immunopathology; Relapse; Respiratory disease; tuberculosis treatment; Immune reconstitution; AIDS; Mycobacterial infection; Immune deficiency; Infection; Treatment; Tuberculosis; Viral disease; Bacteriosis; Clinical trial; HIV infection; tuberculosis relapse
• ISSN: 1027-3719; 1815-7920

SETTING: Studies on tuberculosis (TB) relapse in HIV-infected patients show contradictory results regarding the optimal duration of treatment.OBJECTIVE: To assess the incidence of TB relapse and associated factors in HIV-infected patients receiving a 9-month tuberculostatic regimen and concomitant HAART.PATIENTS AND METHODS: Observational prospective study recording 156 episodes of TB in 137 patients, most of whom were on a 9-month regimen of daily isoniazid and rifampicin-based TB treatment. The primary outcome measure was relapse after completion of therapy.RESULTS: Forty episodes were excluded due to death or loss to follow-up. The median follow-up was 24 months. Twenty-seven episodes of TB relapse were observed in 22 patients, yielding a relapse rate of 1.9/100 patient-years in those on a regimen of ≥9 months. A high recurrence rate was observed in those who had prematurely suspended treatment. Treatment duration ≥9 months and achieving both an undetectable viral load and increasing CD4-cell counts with HAART were associated with the absence of TB relapses.CONCLUSIONS: Considering its safety and tolerance, our results suggest that a 9-month regimen would be recommendable in patients with severe immunosuppression until the optimal duration of TB treatment in HIV-infected patients has been defined in a randomised clinical trial including HAART.