Long term follow up of HIV-infected patients with tuberculosis treated with 6-month intermittent short course chemotherapy.

Swaminathan, S.; Deivanayagam, C.N.; Rajsekaran, S.; Venkatesan, P.; Padmapriyadarsini, C.; Menon, P.A.; Ponnuraja, C.; Dilip, M.

The National Medical Journal of India; 2008; 21; 3-8.

Abstract: 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 anti tuberculosis 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 upto 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 anti retroviral 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 1.8x10 5 at base line to1.3x10 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 anti tuberculosis regimen was satisfactory, the over all 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 inspite of anti tuberculosis treatment, highlighting the need for anti retroviral 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.

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