Vjecha M, Okwera A, Byekwaso F, Nakibali J, Nyole S, Okot-Nwang M, Aisu T, Eriki P, Mugerwa RD, Daniel T; International Conference on AIDS.
Int Conf AIDS. 1992 Jul 19-24; 8: B180 (abstract no. PoB 3560).
Case Western Reserve U., Cleveland, OH.
OBJECTIVE: To assess the predictors of mortality and toxicity in HIV-infected persons being treated for pulmonary TB in a comparative trial of 2STH/10TH vs. 2RHZ/TRH at Makerere University. METHODS: Between May 1990 and September 1991, patients with suspected pulmonary TB were sequentially screened with sputum smear and culture for AFB; HIV-1 ELISA and Western Blot; and Mantoux testing with 5 TU PPD. Exclusion criteria included age less than 15 or greater than 60, pregnancy, previous treatment for TB, Karnofsky score less than 50%, Hgb less than 8 gm/dl, WBC count less than 3000/mm3. Survival was measured from the onset of treatment. RESULTS: Of 331 patients with pulmonary TB, 218 (0.66) were seropositive for HIV-1. As of March 1990, 50/196 HIV (0.30) HIV + TB patients had died, a mean of 5 months (2d-18.4 months) after starting therapy; mean duration of follow-up in those still alive is 12.9 months (5.5-20.5 months). Other opportunistic infections were noted prior to therapy in 17(0.29) of the dead vs. 12(0.09) of those alive. Anergy to PPD was 3.9-more frequent in those that died 32/58 (0.55) compared to those alive 24/137 (0.18) and was unrelated to presence of a BCG scar. The following factors were associated with shorter survival in those who died: anergy (4.0 months); STH Rx (3.9 months) and anergy plus STH Rx (2.9 months). Follow-up sputum cultures were available from 0.64 of the fatal cases and showed evidence of partial or complete clearing of AFB in 29 (0.76). Toxic drug reaction occurred in 10/94 (0.11) of patients on STH and 1/94 (0.01) on RHZ. Six of the 8 skin reactions on STH including the only case of Stevens-Johnson syndrome occurred in patients anergic to PPD. CONCLUSIONS: Previous opportunistic infections and cutaneous anergy to PPD were predictive of death during treatment of pulmonary TB in HIV-infected patients. Treatment with STH also was associated with shorter survival in the fatal cases. The STH regimen was more toxic; cutaneous anergy to PPD increased the risk of skin rash on STH. Death in most patients occurred despite evidence of a microbiologic response to therapy. The presence of anergy in TB patients probably warrants treatment with a rifampin-containing regimen.
Publication Types:
Keywords:
- AIDS Vaccines
- Acquired Immunodeficiency Syndrome
- BCG Vaccine
- Drug Toxicity
- Female
- HIV Infections
- HIV Seropositivity
- HIV-1
- Humans
- Pregnancy
- Rifampin
- Sputum
- Stevens-Johnson Syndrome
- Tuberculin
- Tuberculin Test
- Tuberculosis, Pulmonary
- Uganda
- immunology
- mortality
Other ID:
UI: 102199006
From Meeting Abstracts