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HIV patients with TB may benefit from longer therapy
NEW YORK (Reuters Health) - HIV-infected patients who received a 6-month rifamycin-based course of TB treatment had a higher relapse rate than patients who received lengthier treatment, researchers report in the June 1st issue of the American Journal of Respiratory and Critical Care Medicine.
Dr. Payam Nahid of the University of California, San Francisco and colleagues note that the optimal length of TB treatment in patients co-infected with HIV is unknown.
To investigate further, the researchers conducted a retrospective analysis of data for 700 patients who reported for treatment at a San Francisco TB center. Of these, 264 (38%) were HIV infected, 315 (45%) were not infected, and 121 (17%) were not tested.
The mean treatment duration was 10.2 months in the HIV group and 8.4 months in the other patients. The relapse rate among HIV-infected patients was 9.3 per 100 person-years versus 1.0 per 100 person-years in the other patients.
The 17% of HIV patients and 37% of other patients who received a standard 6 months of rifamycin-based therapy were significantly more likely to relapse than those who had longer treatment (adjusted hazard ratio, 4.33).
Patients with HIV who received intermittent therapy were also more likely to relapse than those given daily treatment (adjusted hazard ratio, 4.12).
The team did find that use of highly active antiretroviral therapy was associated with more rapid conversion of smears and cultures (3.5 versus 5.9 weeks) and with improved survival (relative risk, 0.36).
Dr. Nahid told Reuters Health that the cohort of HIV-infected patients who received 6 months of rifamycin-based treatment had characteristics suggesting that they were ideal candidates for short-course regimen, but nevertheless they had an increased rate of relapse.
"Although a retrospective analysis cannot be directly compared to the outcomes of clinical trials," he pointed out, "the findings from our study suggest that in actual practice, the ideal duration of treatment has yet to be determined."
Am J Respir Crit Care Med 2007;175:1199-1206.
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