Pattern of defervescence in response to anti tuberculosis therapy in patients with extrapulmonary tuberculosis and advanced human immunodeficiency virus infection

The pattern of fever response to empiric anti-tuberculosis therapy in patie nts with tuberculosis (TB) and human immunodeficiency virus (HN) infection, and the relationship between fever response patterns and anti-TB drug susc eptibility profiles of Mycobacterium tuberculosis isolates are rarely descr ibed. In this study, we evaluated the fever responses to a four-drug anti-T B regimen in 26 HPV-infected patients with culture-proven extrapulmonary TB , and compared the results with those in 12 patients with disseminated Myco bacterium avium complex (DMAC) infection treated with a clarithromycin-cont aining regimen. The CD4 lymphocyte counts did not differ significantly betw een TB and DMAC patients (26 x 10(6)/L in TB patients vs 5 x 10(6)/L in DMA C patients). Drug susceptibility data were available for 22 patients with T B. Most TB patients had rapid defervescence after initiation of anti-TB the rapy. Fever resolved within 1 week in 85% (22/26) of patients, including th ree of six (50%) with multidrug-resistant (MDR) TB. The median duration of fever in patients with drug-susceptible TB was similar to that in patients with drug-resistant TB (3 vs 4 days, p = 0.33). However, patients with MDR- TB were more likely than those with non-MDR TB to have fevers lasting longe r than 1 week after initiating anti-TB therapy (3/6 vs 1/16, p = 0.046). On ly 17% (2/12) of the patients with DMAC infection became afebrile within 1 week of begining anti-MAC therapy (p < 0.001 vs those with TB). Our observa tions suggest that in HIV-infected patients with advanced immunosuppression , anti-TB regimens achieve significantly faster defervescence in TB patient s than do anti-MAC regimens in DMAC patients. Rapid defervescence in patien ts with TB does not necessarily indicate that TB isolates are not MDR strai ns.