CLINICAL-EXPERIENCE WITH RIFAMPIN-ISONIAZID-STREPTOMYCIN-ETHAMBUTOL (RISE)-RESISTANT TUBERCULOSIS

We review demographic and clinical features of 55 patients with rifamp in-isoniazid-streptomycin-ethambutol (RISE)-resistant tuberculosis in our hospital from April 1, 1991, to July 31, 1993. Fifty-one of the 55 patients (median age, 36 years) were seropositive for human immunodef iciency virus (HIV)? and 49 had AIDS. Among the HIV-infected patients, the median CD4 cell count was 31/mm(3), Forty-two patients died durin g the study period. Exogenous reinfection or superinfection with RISE- resistant tuberculosis occurred in 12 of 55 patients with a prior hist ory of tuberculosis infection or disease. Fourteen of 55 received appr opriate therapy, eight of whom became culture negative after a median of 68 days, Twelve of the 14 appropriately treated patients survived a t least 6 months, When appropriately managed, even severely immunosupp ressed individuals with HIV infection may have their RISE-resistant tu berculosis successfully controlled or eradicated, This infection howev er, remains highly lethal in the majority of patients with AIDS, Patie nts remain infectious for prolonged periods, even after appropriate th erapy has been initiated.