7th Conference - Abstract 259

Treatment of Tuberculosis (TB) in HIV-Infected Patients: A Complicated Course of Therapy

M. DWORKIN*, S. MCCOMBS, M. ADAMS, J. JONES, A. DAVIDSON, D. COHN, W. MCCARTHY, M. THOMPSON, A. MORSE, C. HORWITCH, and S. BUSKIN. CDC, Atlanta, GA, and the Adult and Adolescent Spectrum of HIV Disease Project

In the past decade, many new medications have been used to treat HIV-infected patients; several have potential to interact with and complicate TB therapy. Few data are available from routine clinical practice on this subject in the United States in recent years. We reviewed medical records of 146 episodes of culture-positive TB diagnosed in 143 HIV-infected patients identified in the CDC's Adult/Adolescent Spectrum of HIV Disease project and treated during 1988-1999 in New Orleans (43), Seattle (42), Atlanta (40), and Denver (18). Therapy was administered by directly observed therapy (DOT) alone (81), a combination of DOT and self-administered therapy (SAT)(47), SAT alone (4), and unknown method (14). A rifamycin derivative (rifampin or rifabutin) and a medication known to interact with rifamycins (e.g., protease inhibitors, oral contraceptives, itraconazole, etc.) was prescribed in 100 (68%) episodes. During 1997-1999 (n=19), a PI was prescribed concomitantly with a rifamycin derivative in 8 episodes (42%). Hepatitis (viral, alcoholic, or other) or other chronic liver disease was present at the time of initial TB diagnosis in 21 (14%); 14 of whom had significantly elevated transaminases (>2 X normal AST or ALT). Hepatitis or chronic liver disease was diagnosed during TB treatment in 8 episodes and was attributed to the TB medications in 3 (2%). Any elevation of transaminases (elevation of AST or ALT above normal range) occurred during the first month of TB therapy in 76 (52%) patients and in 108 (74%) patients ever during TB treatment. Significant elevation of transaminases occurred during the first month of TB therapy in 44 (30%) episodes and in 67 (46%) ever during TB treatment. Persons co-infected with TB and HIV often have conditions which complicate the treatment of both illnesses and a high frequency of prescription of medications which may interact. We recommend that treatment of persons co-infected with TB and HIV be monitored by health-care providers with thorough knowledge of these two diseases.

Key Words: hepatitis, transaminitis, tuberculosis