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Previous Volume 332:779-785 March 23, 1995 Number 12 Next

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ABSTRACT

Background We studied the efficacy of a short-course regimen of chemotherapy for pulmonary tuberculosis in Kinshasa, Zaire. We also assessed whether, among patients with human immunodeficiency virus (HIV) infection, treatment should be extended from 6 to 12 months.

Methods HIV-seropositive and HIV-seronegative outpatients with pulmonary tuberculosis were treated with rifampin, isoniazid, pyrazinamide, and ethambutol daily for two months, followed by rifampin plus isoniazid twice weekly for four months. The HIV-positive patients who had no evidence of tuberculosis were then randomly assigned to receive either rifampin plus isoniazid or placebo twice weekly for a further six months. We also followed a comparison group of HIV-seronegative patients who received no further treatment for tuberculosis after six months.

Results After six months, 260 of 335 HIV-seropositive and 186 of 188 HIV-seronegative participants could be evaluated, and their rates of treatment failure were similar: 3.8 and 2.7 percent, respectively. At 24 months, the HIV-seropositive patients who received extended treatment had a relapse rate of 1.9 percent, as compared with 9 percent among the HIV-seropositive patients who received placebo for the second 6 months (P<0.01). Extended treatment did not improve survival, however. Among the HIV-seronegative patients, 5.3 percent relapsed.

Conclusions Among HIV-seropositive patients with pulmonary tuberculosis, extending treatment from 6 to 12 months reduces the rate of relapse but does not improve survival. The six-month program of partly intermittent antituberculous treatment may be an acceptable alternative when resources are limited.

Source Information

From Projet SIDA, Kinshasa, Zaire (J.H.P., M.E.S., Y.B.M., C.B., J.K.M., R.W.R.); the Institute of Tropical Medicine, Antwerp, Belgium (J.H.P., F. Portaels, P.P.); the Belgian Agency for Development and Cooperation, Brussels (J.H.P., J.-C.W.); the Division of HIV and AIDS, Centers for Disease Control and Prevention, Atlanta (M.E.S.); the National Institute of Allergy and Infectious Diseases, Bethesda, Md. (C.B.); the Université Catholique de Louvain, Mont Godinne, Belgium (J.P., F. Pouthier); the Bureau National de la Tuberculose, Kinshasa, Zaire (J.-C.W.); the Centre de Dépistage de la Tuberculose, Kinshasa, Zaire (M.K.); and the Marion Merrell Dow Research Institute, Winnersh, United Kingdom (G.R.).

Address reprint requests to Dr. Perriëns at Clinical Research and Product Development, Division of Research and Intervention Development, Global Program on AIDS, World Health Organization, Ave. Appia, CH-1211 Geneva 27, Switzerland.

Full Text of this Article

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Treatment of Tuberculosis in HIV-Infected Patients in Zaire
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Extract | Full Text  
N Engl J Med 1995; 333:519-520, Aug 24, 1995. Correspondence

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