Relapse and acquired rifampin resistance in HIV-infected patients with tuberculosis treated with rifampin- or rifabutin-based regimens in New York City, 1997-2000
Relapse and acquired rifampin resistance in HIV-infected patients with tuberculosis treated with rifampin- or rifabutin-based regimens in New York City, 1997-2000
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DOI：
10.1086/430377
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发表时间：
2005-07-01
影响因子：
11.8
通讯作者：
Sackoff, J
中科院分区：
文献类型：
--
作者：
Li, JH;Munsiff, SS;Sackoff, J
背景在人类免疫缺陷病毒（HIV）感染的结核病（TB）患者中，利福霉素的使用与获得性利福平耐药（ARR）的复发或治疗失败之间的关系尚不清楚。我们进行了一项回顾性队列研究，研究对象为对利福平敏感的HIV感染者和未感染者，目的是：（1）根据HIV血清状态比较复发率、ARR和治疗失败率;（2）研究在HIV感染的TB患者中，利福霉素的使用是否以及如何与临床结果相关。HIV感染患者比未感染HIV的患者更容易发生ARR（0.9% vs. 0.1%; P = 0.007），在多变量分析中，这种相关性仍然显著（校正比值比[OR]，5.5; 95%置信区间[CI]，1.4-21.5）。在HIV感染的TB患者中，57例单独接受以利福布汀为基础的方案治疗的患者中无一例发生ARR，395例接受利福布汀联合以利福平为基础的方案治疗的患者中仅1例发生ARR，而355例单独接受以利福平为基础的方案治疗的患者中有6例发生复发和ARR。如果在强化治疗阶段开始间断给药，单独接受以利福平为基础的方案治疗的HIV感染患者与未接受间断给药的患者相比，复发和发生利福平耐药的风险更高（复发的风险比[HR]为6.7 [95% CI，1.1-40.1]; ARR的HR为6.4 [95% CI，1.1-38.4]）。当仅限于CD 4（+）T淋巴细胞计数< 100个淋巴细胞/mm 2的患者时，这种关联仍然存在（3）。仅在强化治疗阶段后开始间歇给药并不增加HIV感染TB患者复发和ARR的风险。艾滋病毒感染结核病患者ARR的风险并不取决于所使用的利福霉素，而是取决于强化治疗阶段的利福平给药方案。
Background. The relationship between rifamycin use and either relapse or treatment failure with acquired rifampin resistance (ARR) among human immunodeficiency virus (HIV)-infected patients with tuberculosis (TB) is not well understood.Methods. We conducted a retrospective cohort study of HIV-infected and HIV-uninfected persons with rifampin-susceptible TB, (1) to compare relapse rates, ARR, and treatment failure, according to HIV serostatus; and (2) to examine whether and how use of rifamycin was associated with clinical outcomes of interest among HIV-infected patients with TB.Results. HIV-infected patients were more likely to have ARR than were HIV-uninfected patients (0.9% vs. 0.1%; P = .007), and the association remained significant in multivariate analysis ( adjusted odds ratio [OR], 5.5; 95% confidence interval [CI], 1.4-21.5). Among HIV-infected patients with TB, none of 57 patients treated with rifabutin-based regimens alone had ARR, and only 1 of 395 patients treated with rifabutin given in combination with a rifampin-based regimen had ARR, whereas 6 of 355 patients treated with a rifampin-based regimen alone had relapse and ARR. HIV-infected patients treated with rifampin-based regimens alone had a higher risk for relapse and development of rifampin resistance if intermittent dosing of rifampin was started during the intensive phase of treatment, compared with patients who did not receive intermittent dosing (hazard ratio [HR] for relapse, 6.7 [95% CI, 1.1-40.1]; HR for ARR, 6.4 [95% CI, 1.1-38.4]). This association remained when confined to patients with a CD4(+) T lymphocyte count of < 100 lymphocytes/mm(3). Intermittent dosing started only after the intensive phase of treatment did not increase the risks of relapse and ARR among HIV-infected patients with TB.Conclusion. The risk for ARR among HIV-infected persons with TB did not depend on the rifamycin used but, rather, on the rifampin dosing schedule in the intensive phase of treatment.