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Effectiveness of supervised, intermittent therapy for tuberculosis in HIV-infected patients
K Alwood1, J Keruly, K Moore-Rice
1Johns Hopkins University School of Medicine, Baltimore, MD 21205.
Objective:
To evaluate the effectiveness of supervised therapy for tuberculosis (TB) in patients with HIV infection.
Design:
Retrospective, chart review.
Patients:
Patients with TB and HIV infection.
Setting:
Urban, public TB clinic.
Main Measures And Results:
A total of 107 patients with TB and HIV infection were studied. Most were men (78%), African American (91%), uninsured or on Medicaid (88%), and 67% were injecting drug users. TB was diagnosed before AIDS in 31% of subjects, at the time of AIDS in 32%, and after AIDS in 37%. Clinical features varied by stage of HIV disease. Sixteen patients received no therapy and died before TB was diagnosed, 10 died during the first 8 weeks of treatment. Seventy-eight patients received > 8 weeks therapy, of whom 48 (62%) were given directly observed therapy twice weekly and 30 (38%) received self-administered daily therapy. Patients who received directly observed therapy were more likely to complete 6 months of therapy (96 versus 76%, P = 0.02) and more likely to survive after therapy ended (85 versus 57%, P = 0.01). By logistic regression, directly observed therapy, AIDS diagnosed before TB, and age were significantly associated with survival outcome.
Conclusion:
Directly observed therapy for TB in patients with HIV infection is highly effective and associated with better adherence to therapy and survival.