Pulido F, Peña J M, Rubio R, Moreno S, González J, Guijarro C, Costa J R, Vázquez J J
Unidades VIH, Hospital 12 de Octubre, Madrid, Spain.
Arch Intern Med. 1997 Jan 27;157(2):227-32.
To evaluate the relapse rate of tuberculosis after a complete course of antituberculous therapy in human immunodeficiency virus-infected patients and to identify the risk factors for relapse.
Historic cohort study of all adult patients who were diagnosed as having human immunodeficiency virus infection and a first episode of culture-proved tuberculosis at 2 university hospitals in Madrid, Spain, between 1986 and 1992, and who completed at least 6 months of treatment were included and followed up until September 1994.
Of 276 patients with human immunodeficiency virus infection and tuberculosis, 87 could not be evaluated (6 died before treatment, 39 died during treatment, 36 did not complete the planned therapy, and 6 were unavailable during treatment). The remaining 189 received a standard regimen (ie, 3 or 4 drugs, always including rifampin and isoniazid, for > or = 6 months). The median duration of follow-up for these 189 patients was 31.5 months, with a total of 4668 patient-months of follow-up after treatment; 105 patients (56%) were followed up until death. The relapse rate was 7.9% (2.7/100 patient-years). With multivariate analysis, a shorter duration of treatment and a low CD4+ cell count were associated with a greater probability of relapse. Relapses occurred in 5 (3.4%) of 148 patients who were treated for 9 or more months (1.7/100 patient-years) and in 10 (24%) of 41 patients who were treated for less than 9 months (10.9/100 patient-years) (P < .001; relative hazard, 9.2; 95% confidence interval, 3.1-26.9).
As standard antituberculous therapy for 9 months is associated with a low rate of relapse, maintenance therapy is not required. Duration of treatment for less than 9 months is associated with a high rate of relapse.
评估接受完整疗程抗结核治疗的人类免疫缺陷病毒（HIV）感染患者的结核病复发率，并确定复发的危险因素。
对1986年至1992年间在西班牙马德里的2所大学医院被诊断为HIV感染且首次经培养证实患有结核病、并完成至少6个月治疗的所有成年患者进行历史性队列研究，随访至1994年9月。
276例HIV感染合并结核病患者中，87例无法评估（6例在治疗前死亡，39例在治疗期间死亡，36例未完成计划治疗，6例在治疗期间失访）。其余189例接受标准方案治疗（即3或4种药物，始终包括利福平和异烟肼，治疗≥6个月）。这189例患者的中位随访时间为31.5个月，治疗后总随访时间为4668患者-月；105例患者（56%）随访至死亡。复发率为7.9%（2.7/100患者-年）。多因素分析显示，治疗时间较短和CD4+细胞计数较低与复发可能性较大相关。148例接受9个月或更长时间治疗的患者中有5例（3.4%）复发（1.7/100患者-年），41例接受少于9个月治疗的患者中有10例（24%）复发（10.9/100患者-年）（P<.001；相对风险，9.2；95%置信区间，3.1-26.9）。
由于9个月的标准抗结核治疗复发率较低，无需维持治疗。治疗时间少于9个月与高复发率相关。
