Davies G R, Connolly C, Sturm A W, McAdam K P, Wilkinson D
Hlabisa Hospital, South Africa.
AIDS. 1999 May 7;13(7):811-7. doi: 10.1097/00002030-199905070-00010.
To determine the effectiveness of twice-weekly directly observed therapy (DOT) for tuberculosis (TB) in HIV-infected and uninfected patients, irrespective of their previous treatment history. Also to determine the predictive value of 2-3 month smears on treatment outcome.
Four hundred and sixteen new and 113 previously treated adults with culture positive pulmonary TB (58% HIV infected, 9% combined drug resistance) in Hlabisa, South Africa. Daily isoniazid (H), rifampicin (R), pyrazinamide (Z) and ethambutol (E) given in hospital (median 17 days), followed by HRZE twice a week to 2 months and HR twice a week to 6 months in the community.
Outcomes at 6 months among the 416 new patients were: transferred out 2%; interrupted treatment 17%; completed treatment 3%; failure 2%; and cured 71%. Outcomes were similar among HIV-infected and uninfected patients except for death (6 versus 2%; P = 0.03). Cure was frequent among adherent HIV-infected (97%; 95% CI 94-99%) and uninfected (96%; 95% CI 92-99%) new patients. Outcomes were similar among previously treated and new patients, except for death (11 versus 4%; P = 0.01), and cure among adherent previously treated patients 97% (95% CI 92-99%) was high. Smear results at 2 months did not predict the final outcome.
A twice-weekly rifampicin-containing drug regimen given under DOT cures most adherent patients irrespective of HIV status and previous treatment history. The 2 month smear may be safely omitted. Relapse rates need to be determined, and an improved system of keeping treatment interrupters on therapy is needed. Simplified TB treatment may aid implementation of the DOTS strategy in settings with high TB caseloads secondary to the HIV epidemic.
确定针对感染和未感染HIV的患者，无论其既往治疗史如何，每周两次的直接观察治疗（DOT）方案对结核病（TB）的疗效。同时确定2至3个月痰涂片检查结果对治疗转归的预测价值。
在南非赫拉比萨，对416例新诊断的和113例既往接受过治疗的痰培养阳性的肺结核成年患者进行研究（58%感染HIV，9%合并耐药）。患者在医院接受每日异烟肼（H）、利福平（R）、吡嗪酰胺（Z）和乙胺丁醇（E）治疗（中位治疗17天），随后在社区接受每周两次的HRZE方案治疗2个月，以及每周两次的HR方案治疗6个月。
416例新患者6个月时的治疗转归情况为：转出2%；中断治疗17%；完成治疗3%；治疗失败2%；治愈71%。除死亡情况外（6%对2%；P = 0.03），HIV感染患者和未感染患者的治疗转归相似。在坚持治疗的新患者中，HIV感染患者（97%；95%CI 94 - 99%）和未感染患者（96%；95%CI 92 - 99%）的治愈率都很高。既往接受过治疗的患者和新患者的治疗转归相似，除死亡情况外（11%对4%；P = 0.01），坚持治疗的既往接受过治疗的患者治愈率高达97%（95%CI 92 - 99%）。2个月时的痰涂片检查结果不能预测最终治疗转归。
在直接观察治疗下给予含利福平的每周两次给药方案可治愈大多数坚持治疗的患者，无论其HIV感染状态和既往治疗史如何。可以安全地省略2个月时的痰涂片检查。需要确定复发率，并需要改进使治疗中断者继续治疗的系统。简化的结核病治疗可能有助于在因HIV流行导致结核病高负担地区实施直接观察短程治疗策略。
