Longer Treatment Recommended for Coinfected Patients

Patients coinfected with TB and HIV have a heightened risk of TB relapse, according to recent research by Cynthia R. Driver and colleagues from the New York City Department of Health Tuberculosis Control Program. Coinfected patients should receive longer treatment regimens or be checked regularly for TB recurrence, they said.

Driver and coworkers evaluated therapy outcomes in a cohort of 4,571 patients who had received at least 24 weeks of standard 4-drug TB treatment -- isoniazid, rifampin, pyraxinamide and ethambutol (or streptomycin). None of the patients carried drug-resistant TB. TB "recurrence" was defined as having a positive culture less than 30 days after the last treatment date and "relapse" as having a positive culture more than 30 days after the last treatment.

The study found that the rate of recurrence and relapse was 2.0 per 100 person-years in coinfected patients, compared with a rate of 0.4 per 100 person-years in HIV-negative TB patients. A treatment regimen lasting 36 weeks or less was associated with a significantly higher recurrence risk in HIV patients.

The authors stressed that clinicians should be aware of the possibility of recurrence of TB six to nine months after the start of treatment. Sputum evaluation at three months after completion of treatment should be performed on all persons infected with HIV who received a shorter regimen, they said. The full study, "Relapse in Persons Treated for Drug-susceptible Tuberculosis in a Population with High Coinfection with Human Immunodeficiency Virus in New York City," is published in Clinical Infectious Disease, November 15, 2001;33(10):1762-1769.

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