Sputum culture conversion with moxifloxacin-containing regimens in the treatment of patients with newly diagnosed sputum-positive pulmonary tuberculosis in South India.

BACKGROUND: Rapid sputum culture conversion at 2 months indicates the sterilizing capacity and potential of regimens to shorten duration of tuberculosis treatment. We compared results of sputum culture conversion by moxifloxacin and control regimens and identified factors affecting sputum culture positivity after 2 months of treatment. METHODS: Human immunodeficiency virus-uninfected adults with newly diagnosed smear-positive pulmonary tuberculosis were randomized to receive a 3- or 4-month moxifloxacin regimen (moxifloxacin [M], isoniazid [H], rifampicin [R], pyrazinamide [Z], ethambutol [E]) or the control regimen (RHZE thrice weekly). Bacteriological assessments were done at 15, 30, 45, and 60 days of treatment. Because all patients in the moxifloxacin groups received 2 months of daily RHZEM, they were grouped together for analysis. Statistical methods included χ(2) test and logistic regression analysis. RESULTS: Sputum culture conversion was analyzed in 780 (616 in the moxifloxacin group and 164 in the control group) of 801 enrolled patients. Ninety-five percent of 590 patients in the moxifloxacin group and 81% of 151 patients in the control group had negative sputum cultures at month 2 (P < .001). The control regimen, age (≥35 years), initial sputum culture grade (2+ or 3+), and male sex were significantly associated with higher odds of positive sputum cultures at 2 months. CONCLUSIONS: A 5-drug daily regimen with moxifloxacin results in significantly higher sputum culture conversion in the first 2 months compared with a thrice-weekly, 4-drug regimen in patients with newly diagnosed sputum-positive pulmonary tuberculosis.

Nutritional supplementation in HIV-infected individuals in South India: a prospective interventional study.

BACKGROUND: Malnutrition in human immunodeficiency virus (HIV)-infected individuals is associated with faster disease progression, higher mortality rates, and suboptimal response to antiretroviral therapy (ART). METHODS: We conducted a prospective interventional study to evaluate the effects of an oral macronutrient supplement among HIV-infected adults in South India. Patients attending Tuberculosis Research Centre clinics from June 2005 through December 2007 had baseline nutritional assessment and laboratory investigations performed. Patients at 1 center received nutritional counseling and standard care, whereas patients at 2 centers additionally received a macronutrient providing 400 cal and 15 g of protein daily. Study outcomes were changes in anthropometry, body composition, blood chemistry, and immune status at 6 months. RESULTS: In total, 636 ART-naive patients were enrolled in the study; 361 completed 6 months of follow-up (282 received supplements and 79 received standard care). Mean age +/- standard deviation (SD) was 31 +/- 7 years, mean weight +/- SD was 50 +/- 10 kg, and 42% were male. Significant increases in body weight, body mass index, midarm circumference, fat-free mass, and body cell mass were observed in the supplement group but not in the control group at 6 months; gains were greater in patients with CD4 cell counts <200 cells/microL. No changes were observed in lipid levels, whereas the CD4 cell count decreased in the control group. However, after adjusting for baseline differences, these changes were not statistically significantly different between the groups. CONCLUSIONS: Macronutrient supplementation did not result in significantly increased weight gain compared with standard care (including nutritional counseling) among patients with moderately advanced HIV disease. The effect of supplementation on specific subsets of patients and on preserving immune function needs further research.

Anti-tuberculosis drug resistance in patients with HIV and tuberculosis in South India.

SETTING: Tuberculosis Research Centre clinics at Chennai and Madurai, Tamil Nadu, South India. OBJECTIVES: To investigate the prevalence and pattern of drug resistance among patients with HIV and pulmonary tuberculosis (PTB). DESIGN: Prospective cohort study of HIV-positive patients with PTB between January 2001 and May 2003. Sputum mycobacterial culture and drug susceptibility testing were performed. RESULTS: A total of 204 patients with positive sputum cultures for Mycobacterium tuberculosis were included; 167 of them were new cases, and 37 had a history of previous anti-tuberculosis treatment for > 1 month. Among the former, resistance to isoniazid (INH) was observed in 22 (13%) and MDR-TB in 7 (4.2%). Reported resistance rates in this geographic area among new cases ranged from 15% to 28% for INH and 2.8% to 3.4% for MDR (INH + rifampicin [RMP]). In contrast, among HIV-positive patients with a history of previous treatment, resistance was found to INH in 10 (27%) and to RMP in 7 (18.9%), while MDR-TB was seen in 5 (13.5%) patients. CONCLUSION: Among new TB patients, MDR-TB is marginally higher in HIV-positive patients than in the non-HIV-infected population in this region. Standard treatment guidelines should be followed. Higher rates of drug resistance are observed among previously treated patients.

Vitamin A levels in sputum-positive pulmonary tuberculosis patients in comparison with household contacts and healthy 'normals'.

OBJECTIVE: To estimate serum vitamin A in pulmonary tuberculosis (PTB) patients at the start and end of anti-tuberculosis treatment. DESIGN: Serum vitamin A was estimated in 47 PTB patients (pre and post treatment), 46 healthy household contacts and 30 healthy 'normals'. RESULTS: Mean serum vitamin A in patients at the start of treatment was 21.2 microg/dl, which was significantly lower than in household contacts (42.2 microg/dl) and healthy 'normals' (48.1 microg/dl). The vitamin A levels in patients increased following treatment. CONCLUSION: The low vitamin A levels observed in patients returned to normal at the end of anti-tuberculosis treatment without vitamin A supplementation.