A PROSPECTIVE EVALUATION OF ANTITUBERCULOSIS THERAPY IN PATIENTS WITHHUMAN-IMMUNODEFICIENCY-VIRUS INFECTION

The purpose of this study was to determine the efficacy and toxicity o f a standard antituberculosis regimen in patients with human immunodef iciency virus (HIV) infection. We prospectively evaluated 89 patients with tuberculosis and HIV infection at an urban medical center. Eighty -two patients received isoniazid, rifampin, and pyrazinamide, with or without ethambutol, for 2 mo, followed by isoniazid and rifampin for 7 mo. Seven patients received other regimens because of drug resistance or intolerance. Therapy was self-administered in 57 patients and dire ctly observed in 32 cases. All patients showed rapid clinical improvem ent during the first month of therapy, and sputum cultures reverted to negative after 3 mo in 52 of 54 patients from whom specimens were obt ained. Adverse reactions to isoniazid or rifampin prompted alterations in antituberculosis regimens in five patients (6%). Forty patients (4 5%) died during follow-up, and tuberculosis was a potential contributo ry cause of death in three cases. Treatment failure occurred in five p atients (6%), four of whom were noncompliant with therapy. The fifth p atient had an isoniazid-resistant organism. No relapses occurred in 91 6 patient-months of follow-up posttreatment. We thus conclude that the 9-mo regimen used for treatment of drug-susceptible tuberculosis in H IV-infected patients is effective and well tolerated.