ABSTRACT
Triple nucleoside reverse transcriptase inhibitors are recommended as an alternative regimen for HIV-infected patients undergoing tuberculosis treatment in resource-limited settings. Few data exist on the efficacy of such regimens in tuberculosis patients. In 34 tuberculosis/HIV-co-infected patients treated with zidovudine/lamivudine/abacavir, 76% achieved HIV RNA less than 50 copies/ml at 24 weeks. No cases of hypersensitivity or immune reconstitution syndrome were observed. These data support the continuing evaluation of nucleoside-based antiretroviral regimens as an alternative treatment for this population.
Subject(s)
Dideoxynucleosides/therapeutic use , HIV Infections/drug therapy , Lamivudine/therapeutic use , Reverse Transcriptase Inhibitors/therapeutic use , Tuberculosis, Pulmonary/drug therapy , Zidovudine/therapeutic use , Adult , Antitubercular Agents/therapeutic use , CD4 Lymphocyte Count , Dideoxynucleosides/adverse effects , Drug Hypersensitivity/etiology , Drug Therapy, Combination , Female , HIV Infections/complications , HIV Infections/immunology , Humans , Lamivudine/adverse effects , Male , Middle Aged , Neutropenia/chemically induced , RNA, Viral/analysis , Reverse Transcriptase Inhibitors/adverse effects , Treatment Outcome , Tuberculosis, Pulmonary/complications , Tuberculosis, Pulmonary/immunology , Zidovudine/adverse effectsABSTRACT
BACKGROUND: The human immunodeficiency virus (HIV) is a key factor responsible for the high rates of tuberculosis (TB) in sub-Saharan Africa. Treatment of TB with rifampicin (R, RMP) containing short-course regimens is highly effective in HIV-infected adults. We conducted a study to compare the efficacy and safety of intermittent ethambutol (E, EMB) with two RMP-containing regimens to treat pulmonary TB in HIV-infected patients. SETTING: National Tuberculosis Treatment Centre, Mulago Hospital, Kampala, Uganda. DESIGN: This was a prospective cohort compared to two non-randomised control groups. The study group and the two control arms were treated with 2 months of isoniazid (H), RMP, pyrazinamide (Z) and EMB followed by 6 E3H3 for the study group and 4HR or 6HR for controls. RESULTS: Between April 1993 and March 2000, 136 patients were enrolled in the 2EHRZ/E3H3 arm, 147 in the 2EHRZ/4HR arm and 266 in the 2EHRZ/6HR arm. The relapse rate was 18.2 per 100 person-years observation (PYO) for the study regimen compared to 9.7/100 PYO (P = 0.0063) and 4.8/100 PYO (P = 0.0001) in patients treated with 2 EHRZ/4HR or 2EHRZ/6HR, respectively. CONCLUSION: The 2EHRZ/6E3H3 regimen is safe and effective but has a significant risk of relapse.
Subject(s)
AIDS-Related Opportunistic Infections/drug therapy , Antitubercular Agents/administration & dosage , Ethambutol/administration & dosage , Rifampin/administration & dosage , Tuberculosis, Pulmonary/drug therapy , Adult , Drug Administration Schedule , Drug Therapy, Combination , Female , Humans , Male , Recurrence , Treatment Outcome , UgandaABSTRACT
Nosocomial tuberculosis (TB) is a serious problem in sub-Saharan Africa due to the absence of protective measures for health care workers (HCWs). To determine the prevalence of TB infection among HCWs in Kampala, Uganda, a cross-sectional study was conducted between June and August 2001. A tuberculin skin test (TST) survey was conducted among 396 HCWs from three hospitals within Kampala, The prevalence of TST > or = 10 mm was 57%. Age and department of employment were associated with TST > or = 10 mm, while occupation and BCG status were not. Health care workers in Kampala, Uganda, have a high prevalence of latent TB infection.
