The treatment of tuberculosis in HIV-infected persons

Pozniak, A.; Miller, R F; Ormerod, L P

doi:10.1097/00002030-199903110-00001

Cited by 69 publications

(24 citation statements)

References 61 publications

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“…The higher cure rate of regimens containing rifampin has been well documented, in other countries, (9) as well as in Brazil. (10) Although HIV infection without ART (RR = 9.64); lack of bacteriological confirmation (RR = 4.00); diabetes mellitus (RR = 3.94); and homosexual/bisexual behavior (RR = 2.97). The rate of treatment failure was 1.9%.…”

Section: Discussionmentioning

confidence: 99%

Preditores dos desfechos do tratamento da tuberculose

Brasil

Trajman

et al. 2012

J. bras. pneumol.

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Objective: To analyze tuberculosis treatment outcomes and their predictors. Methods: This was a retrospective longitudinal cohort study involving tuberculosis patients treated between 2004 and 2006 at the Instituto de Pesquisa Evandro Chagas, in the city of Rio de Janeiro. We estimated adjusted risk ratios (ARRs) for the predictors of treatment outcomes. Results: Among 311 patients evaluated, the rates of cure, treatment abandonment, treatment failure, and mortality were 72%, 19%, 2%, and 6%, respectively. Changes in the treatment regimen due to adverse events occurred in 8%. The factors found to reduce the probability of cure were alcoholism (ARR, 0.30), use of the streptomycin+ethambutol+ofloxacin (SEO) regimen (ARR, 0.32), HIV infection without the use of antiretroviral therapy (ART; ARR, 0.36), and use of the rifampin+isoniazid+pyrazinamide+ethamb utol regimen (ARR, 0.58). Being younger and being alcoholic both increased the probability of abandonment (ARR, 3.84 and 1.76, respectively). It was impossible to determine the ARR for the remaining outcomes due to their low prevalence. However, using the relative risk (RR), we identified the following potential predictors of mortality: use of the SEO regimen (RR, 11.43); HIV infection without ART (RR, 9.64); disseminated tuberculosis (RR, 9.09); lack of bacteriological confirmation (RR, 4.00); diabetes mellitus (RR, 3.94); and homosexual/bisexual behavior (RR, 2.97). Low income was a potential predictor of treatment failure (RR, 11.70), whereas disseminated tuberculosis and HIV infection with ART were potential predictors of changes in the regimen due to adverse events (RR, 3.57 and 2.46, respectively). Conclusions: The SEO regimen should not be used for extended periods. The data confirm the importance of ART and suggest the need to use it early.Keywords: Tuberculosis; HIV; Rifampin; Drug toxicity; Risk factors; Medication adherence. ResumoObjetivo: Analisar os desfechos do tratamento da tuberculose e seus preditores. Métodos: Estudo longitudinal de coorte de pacientes com tuberculose tratados entre 2004 e 2006 no Instituto de Pesquisa Evandro Chagas, na cidade do Rio de Janeiro. As razões de risco ajustadas (RRa) dos preditores foram estimadas. Resultados: Foram incluídos 311 pacientes. As taxas de cura, de abandono, de mortalidade e de falha terapêutica foram, respectivamente, 72%, 19%, 6% e 2%. A troca de regime terapêutico por eventos adversos foi necessária em 8%. O alcoolismo (RRa, 0,30), uso do regime estreptomicina+etambutol+ofloxacina (SEO; RRa, 0,32), infecção por HIV sem tratamento antirretroviral (TARV; RRa, 0,36) e o uso do regime rifampicina+isoniazida+pirazinamida+etambutol (RRa, 0,58) reduziram a probabilidade de cura. A faixa etária mais jovem (RRa, 3,84) e o alcoolismo (RRa, 1,76) aumentaram a probabilidade do abandono. Não foi possível determinar as RRa para os demais desfechos devido a suas baixas prevalências. Entretanto, medidas do risco relativo (RR) identificaram os seguintes potenciais preditores do óbito: uso de esquema SEO (RR,1...

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Section: Discussionmentioning

confidence: 99%

Preditores dos desfechos do tratamento da tuberculose

Brasil

Trajman

et al. 2012

J. bras. pneumol.

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“…Data on the adjusted dosages that generally result in therapeutic levels of the antiretrovirals in plasma have been published for the PI saquinavir (17) and the NNRTI efavirenz (10). Pharmacokinetic interactions between rifampin and nucleoside reverse transcriptase inhibitors (NRTIs) are less pronounced, since these agents do not undergo appreciable oxidative metabolism (4,14). A study of the interaction of rifampin with T-20 (enfuvirtide) did not reveal clinically significant changes in the pharmacokinetics of T-20 (Fuzeon; Summary of Product Characteristics, 2003; Roche Registration Limited, Welwyn Garden City, United Kingdom).…”

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confidence: 99%

Pharmacokinetics of Adjusted-Dose Lopinavir-Ritonavir Combined with Rifampin in Healthy Volunteers

Porte

Colbers²,

Bertz

et al. 2004

Antimicrob Agents Chemother

164

143

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Coadministration of lopinavir-ritonavir, an antiretroviral protease inhibitor, at the standard dose (400/100 mg twice a day [BID]) with the antituberculous agent rifampin is contraindicated because of a significant pharmacokinetic interaction due to induction of cytochrome P450 3A by rifampin. In the present study, two adjusted-dose regimens of lopinavir-ritonavir were tested in combination with rifampin. Thirty-two healthy subjects participated in a randomized, two-arm, open-label, multiple-dose, within-subject controlled study. All subjects were treated with lopinavir-ritonavir at 400/100 mg BID from days 1 to 15. From days 16 to 24, the subjects in arm 1 received lopinavir-ritonavir at 800/200 mg BID in a dose titration, and the subjects in arm 2 received lopinavir-ritonavir at 400/400 mg BID in a dose titration. Rifampin was given at 600 mg once daily to all subjects from days 11 to 24. The multiple-dose pharmacokinetics of lopinavir, ritonavir, and rifampin were assessed. Twelve of 32 subjects withdrew from the study. For nine subjects lopinavir-ritonavir combined with rifampin resulted in liver enzyme level elevations. Pharmacokinetic data for 19 subjects were evaluable. Geometric mean ratios for the lopinavir minimum concentration in serum and the maximum concentration in serum (C max ) on day 24 versus that on day 10 were 0.43 (90% confidence interval [CI], 0.19 to 0.96) and 1.02 (90% CI, 0.85 to 1.23), respectively, for arm 1 (n ‫؍‬ 10) and 1.03 (90% CI, 0.68 to 1.56) and 0.93 (90% CI, 0.81 to 1.07), respectively, for arm 2 (n ‫؍‬ 9). Ritonavir exposure increased from days 10 to 24 in both arms. The geometric mean C max of rifampin was 13.5 mg/liter (day 24) and was similar between the two arms. Adjusteddose regimens of lopinavir-ritonavir in combination with therapeutic drug monitoring and monitoring of liver function may allow concomitant use of rifampin.

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“…This might reflect a problem with recordmkeeping, but is also a genuine problem highlighting the difficulties of drug interactions between nevirapine and rifampicin, particularly the effect that rifampicin has in reducing plasma concentrations of nevirapine and therefore potentially creating the risk of drug resistance. 7,8 In Malawi, there is also an administrative problem in that antiretroviral drugs are administered by hospitals while tuberculosis drugs are administered in a decentralized fashion from health centres. 9 Expecting HIVm positive patients with tuberculosis to travel long distances from rural areas to collect antiretroviral drugs is unrealism m tic, and possibly accounts for the small number of patients with tuberculosis who also take antiretroviral therapy.…”

Section: Collection and Interpretation Of Routine Datamentioning

confidence: 99%

Supervision, monitoring and evaluation of nationwide scale-up of antiretroviral therapy in Malawi

Libamba

Makombe

Mhango

et al. 2006

Bull World Health Organ

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Objective To describe the supervision, monitoring and evaluation strategies used to assess the delivery of antiretroviral therapy during nationwide scale-up of treatment in Malawi. Methods In the first quarter of 2005, the HIV Unit of the Ministry of Health and its partners (the Lighthouse Clinic; Médecins Sans Frontières-Belgium, Thyolo district; and WHO's Country Office) undertook structured supervision and monitoring of all public sector health facilities in Malawi delivering antiretroviral therapy. Findings Data monitoring showed that by the end of 2004, there were 13 183 patients (5274 (40%) male, 12 527 (95%) adults) who had ever started antiretroviral therapy. Of patients who had ever started, 82% (10 761/13 183) were alive and taking antiretrovirals; 8% (1026/13 183) were dead; 8% (1039/13 183) had been lost to follow up; < 1% (106/13 183) had stopped treatment; and 2% (251/13 183) had transferred to another facility. Of those alive and on antiretrovirals, 98% (7098/7258) were ambulatory; 85% (6174/7258) were fit to work; 10% (456/4687) had significant side effects; and, based on pill counts, 96% (6824/7114) had taken their treatment correctly. Mistakes in the registration and monitoring of patients were identified and corrected. Drug stocks were checked, and one potential drug stock-out was averted. As a result of the supervisory visits, by the end of March 2005 recruitment of patients to facilities scheduled to start delivering antiretroviral therapy had increased. Conclusion This report demonstrates the importance of early supervision for sites that are starting to deliver antiretroviral therapy, and it shows the value of combining data collection with supervision. Making regular supervisory and monitoring visits to delivery sites are essential for tracking the national scale-up of delivery of antiretrovirals.Keywords HIV infections/drug therapy; Acquired immunodeficiency syndrome/drug therapy; Anti-retroviral agents; National health programs/organization and administration; Program evaluation; Malawi (source: MeSH, NLM). Voir page 325 le résumé en français. En la página 325 figura un resumen en español. Mots clés

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The treatment of tuberculosis in HIV-infected persons

Cited by 69 publications

References 61 publications

Preditores dos desfechos do tratamento da tuberculose

Preditores dos desfechos do tratamento da tuberculose

Pharmacokinetics of Adjusted-Dose Lopinavir-Ritonavir Combined with Rifampin in Healthy Volunteers

Supervision, monitoring and evaluation of nationwide scale-up of antiretroviral therapy in Malawi

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