Journal Article

Risk Factors for Relapse and Acquired Rifamycin Resistance after Directly Observed Tuberculosis Treatment: A Comparison by HIV Serostatus and Rifamycin Use

Richard E. Nettles, Dana Mazo, Karla Alwood, Regina Gachuhi, Gina Maltas, Karen Wendel, Wendy Cronin, Nancy Hooper, William Bishai and Timothy R. Sterling

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 38, issue 5, pages 731-736
Published in print March 2004 | ISSN: 1058-4838
Published online March 2004 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/381675
Risk Factors for Relapse and Acquired Rifamycin Resistance after Directly Observed Tuberculosis Treatment: A Comparison by HIV Serostatus and Rifamycin Use

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We sought to determine the risk of acquired rifamycin resistant (ARR) tuberculosis associated with rifampin- versus rifabutin-based directly observed therapy and to assess the risk factors for relapse of tuberculosis. This observational cohort study included patients with culture-confirmed rifamycin-susceptible tuberculosis reported to the Baltimore City Health Department (Baltimore, MD) during the period of January 1993 through December 2001. Of the 407 patients, 108 (27%) were human immunodeficiency virus (HIV) seropositive, 161 (40%) were HIV seronegative, and 138 (34%) had an unknown serostatus. Three (2.8%) of 108 HIV-seropositive persons had ARR tuberculosis, compared with 0 of 299 persons with negative or unknown HIV serostatus (P = .02). Among HIV-seropositive patients, 3 (3.7%) of 81 who were treated with rifampin and 0 of 27 who were treated with rifabutin had ARR tuberculosis (P = .57). Among HIV-seropositive patients, the only risk factor for recurrent tuberculosis was a low median initial CD4+ T lymphocyte count (51 vs. 138 cells/mm3; P = .02). The median CD4+ T lymphocyte count among patients with ARR tuberculosis was 51 cells/mm3. ARR tuberculosis can occur with rifampin-based regimens, but in this study, the risk was not significantly higher than that for a rifabutin-based regimen.

Journal Article.  3414 words.  Illustrated.

Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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