The most effective duration of treatment for tuberculosis (TB) in order to prevent a relapse in HIV-infected patients is unknown. In the current study, conducted at the Hospitales Universitarios Virgen del Rocio in Seville, Spain, researchers sought to determine the incidence of TB relapse and associated factors in HIV-infected patients receiving a 9-month TB regimen and concomitant HAART.

This was an observational prospective study that recorded 156 episodes of TB in 137 patients, most of whom were on a daily isoniazid and rifampicin-based TB treatment regimen for 9 months. The primary outcome measure was relapse after completion of therapy.

Results

·         Forty episodes were excluded due to death or loss to follow-up. The median follow-up was 24 months.

·         Twenty-seven episodes of TB relapse were observed in 22 patients, yielding a relapse rate of 1.9/100 patient-years in those on a regimen of > or = 9 months.

·         A high recurrence rate was observed in those who had prematurely suspended treatment.

·         Treatment duration > or = 9 months and achieving both an undetectable viral load and increasing CD4-cell counts with HAART were associated with prevention of TB relapses.

Based on their findings in this study, the Spanish researchers conclude, “Our results suggest that a 9-month regimen would be recommendable in patients with severe immunosuppression until the optimal duration of TB treatment in HIV-infected patients has been defined in a randomised clinical trial including HAART.”

02/24/06

Reference
L F Lopez-Cortez and others. Influence of treatment and immunological recovery on tuberculosis relapses in HIV-infected patients. International Journal of Tuberculosis and Lung Diseases 9(12): 1385-1390. December 2005.