EFFECTIVENESS OF SUPERVISED, INTERMITTENT THERAPY FOR TUBERCULOSIS INHIV-INFECTED PATIENTS

Objective: To evaluate the effectiveness of supervised therapy for tub erculosis (TB) in patients with HIV infection. Design: Retrospective, chart review. Patients: Patients with TB and HIV infection. Setting: U rban, public TB clinic. Main measures and results: A total of 107 pati ents with TB and HIV infection were studied. Most were men (78%), Afri can American (91%), uninsured or on Medicaid (88%), and 67% were injec ting drug users. TB was diagnosed before AIDS in 31% of subjects, at t he time of AIDS in 32%, and after AIDS in 37%. Clinical features varie d by stage of HIV disease. Sixteen patients received no therapy and di ed before TB was diagnosed, 10 died during the first 8 weeks of treatm ent. Seventy-eight patients received > 8 weeks therapy, of whom 48 (62 %) were given directly observed therapy twice weekly and 30 (38%) rece ived self-administered daily therapy. Patients who received directly o bserved therapy were more likely to complete 6 months of therapy (96 v ersus 76%, P = 0.02) and more likely to survive after therapy ended (8 5 versus 57%, P = 0.01). By logistic regression, directly observed the rapy, AIDS diagnosed before TB, and age were significantly associated with survival outcome. Conclusion: Directly observed therapy for TB in patients with HIV infection is highly effective and associated with b etter adherence to therapy and survival.