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Factors alJecting outromes inmv·~ted TB

THERAPY

The severity of immune deficiency in patients with HIV·associaled tuberculosis (TB) has a major impact on mortality, according to investigators from Africa and the US. However. the severity of immune deficiency in these patients has no influence on the response to standard short-course antitubercular therapy, they say.

The investigators studied outcomes in 460 patients from the Ivory Coast who had smear-positive tuberculosis; 180 were mY-positive. All patients were treated with a standard 6-month course of daily isoniazid and rifampicin with daily pyrazinamide during the first 2 months.

The mortality rates of mY-positive patients with CD4+ cell counts < 200/mm1 and 200-499/mm3 were 10% and 4%, respectively. These rates were significantly higher than those seen in patients without mv infection (0.4%).

In the 323 patients who completed 6 months' therapy, microbiological response was similarly high in those with and those without IflV infection (93 and 92%, respectively). Response rates did not differ significantly by CD4+ cell Count in HIV-positive patients. Actab AN. Coulibaly D. DiJbm H, Diallo K. Veuct KM. u al. Respcmse 10 IR:&UDml, 1IIOIUIily. mel COot 1~ COlUItS ia HJV-inIci;ud """"'" willi tubcmllosi$ iD Abidj ..... COle d'!voire. LIDceIl4S: 607-610. 11 M. 1995 --