Pulmonary Tuberculosis in Hiv-infected Patients in Zaire - a Controlled Trial of Treatment for Either 6 Or 12 Months
(1995) New England Journal of Medicine — Vol. 332, n° 12, p. 779-784 (1995)
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- 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.
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Perriëns, J. H., Stlouis, ME., Mukadi, YB., Brown, C., Prignot, J., Pouthier, F., Portaels, F., Willame, JC., Mandala, JK., Kaboto, M., Ryder, RW., Roscigno, G., & Piot, P. (1995). Pulmonary Tuberculosis in Hiv-infected Patients in Zaire - a Controlled Trial of Treatment for Either 6 Or 12 Months. New England Journal of Medicine, 332(12), 779-784. https://doi.org/10.1056/NEJM199503233321204 (Original work published 1995)