Efficacy of an unsupervised 8-month rifampicin-containing regimen for the treatment of pulmonary tuberculosis in HIV-infected adults

SETTING: National Tuberculosis Treatment Centre, Mulago Hospital, Kampala, Uganda. OBJECTIVE: To assess the efficacy of a daily, self-administered 8-month rif ampicin-containing regimen for the treatment of pulmonary tuberculosis (TB) in human immunodeficiency virus (HIV) infected adults. DESIGN: Treatment outcomes in patients with pulmonary TB treated with a sin gle 8-month regimen and followed in a prospective epidemiological study. RESULTS: TWO hundred and sixty-five HIV-infected and 26 non-HIV-infected ad ults with initial episodes of pulmonary tuberculosis were treated with 2 mo nths of daily isoniazid (INH), rifampicin (RMP), ethambutol and pyrazinamid e followed by 6 months of daily INH + RMP. Median follow-up was 17.8 months . Ninety-five per cent of the HIV-infected and all of the non-HIV-infected patients who had sputum examined were sputum culture negative after 2 month s of treatment. Twenty-two HIV-infected and no non-HIV-infected patients di ed during treatment. Relapse rates were 8.4% (5,9 per 100 person-years of o bservation [PYO], 95% CI 3.2-8.6) among HIV-infected patients and 4.5% (2.1 /100 PYO, 95% CI 0-7.8) for non-HIV-infected patients. Adverse drug reactio ns occurred in 37% of the HIV-infected patients; most were minor and self-l imiting. CONCLUSION: An 8-month RMP-containing regimen was well tolerated and effect ive in the treatment of HIV-infected adults with initial episodes of pulmon ary TB. Relapse rates were similar to those reported with 6-month short-cou rse regimens in HIV-infected individuals. Decisions about the duration of a nti-tuberculosis treatment for HIV-infected adults must balance programme r esources and the likelihood of poor compliance with longer regimens with th e potential for a modest decrease in relapses with longer treatment.