Treatment of tuberculosis in patients with advanced human immunodeficiency virus infection

Article Abstract:

To learn more concerning the course taken by tuberculosis in patients with human immunodeficiency virus infections (HIV, associated with AIDS), a retrospective study was carried out of 132 patients whose name appeared in both the AIDS and tuberculosis registries over an eight-year period. Patients' medical records also provided information. The patients were classified into three groups: those for whom tuberculosis was the first evidence of AIDS (group 1; 78 people); those who received diagnoses of both AIDS and tuberculosis within a two-week period (group 2; 18 patients); and those who had another AIDS-defining disease before the diagnosis of tuberculosis (group 3; 36 patients). Patients with both diseases were more likely than patients with AIDS only to be black or Latino and to have used intravenous drugs. Approximately one third of all patients had tuberculosis in the lung only, another third had it in the lung and other sites, and the final third had the disease in sites outside the lung only (blood, bone marrow, central nervous system, bowel). One hundred twenty-five patients underwent treatment for tuberculosis (the other seven were diagnosed after death), of whom 66 received a complete course of therapy, and 59, an incomplete course. The medications administered included isoniazid, rifampin, ethambutol, and pyrazinamide, in varying combinations. Twenty-three patients had adverse reactions to a medication, necessitating changes to other agents. One hundred three patients died within the time the study ran: the deaths of 13 were considered related to tuberculosis. Group 1 patients had the longest median survival time (18.4 months); survival times for groups 2 and 3 were 11.7 and 10.6 months, respectively. Three patients had relapses after completing tuberculosis therapy. Although the relapse rate among these HIV-infected people was no higher than among uninfected people in the same geographic region, the rate of adverse drug reactions was higher. If tuberculosis is recognized early and treated appropriately, HIV-infected patients can have a good response to treatment. Clinicians should be aware of the importance of early diagnosis. Unfortunately, patients at risk for both diseases are likely to be noncompliant with tuberculosis treatment regimens. (Consumer Summary produced by Reliance Medical Information, Inc.)

Diagnosis, Development and progression, Drug therapy, Diseases, HIV patients, Tuberculosis

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Projection of AIDS morbidity and mortality in San Francisco

Article Abstract:

The increase in new cases of AIDS (acquired immunodeficiency syndrome) has become a primary focus of concern for public health services in this country. Methods for reliably predicting new cases are needed to anticipate the medical care that will be required for these patients. A predictive model for AIDS has been developed using annual rates of human immunodeficiency virus (HIV) seroconversion (detection of HIV antibodies in the blood) for homosexual and bisexual men and for heterosexual intravenous drug users. Estimates were made using the size of the high risk population and the duration of HIV infection to predict morbidity in San Francisco, CA through June of 1993. The incubation period for the development of AIDS in those who were HIV-positive was ascertained and used as a key parameter; the course of AIDS is known to depend upon the length of infection. Mortality was predicted by using Kaplan-Meier estimates of survival time after initial diagnosis and the projected number of new cases. Data were collected beginning in 1978; the future effects of antiviral therapies, which most likely will be forthcoming, or of earlier treatments on survival rates were not factored into these figures. The median incubation period for AIDS was estimated to be 11.0 years. Based on this model, the number of new AIDS cases in San Francisco by 1993 is expected to be between 12,349 and 17,022, with between 9,966 and 12,767 cumulative deaths. Since 1983, a decline in seroconversion rates has occurred among the San Francisco population of homosexual and bisexual men. Conversely, the number of seroconversions for heterosexual intravenous drug users is expected to increase by about three percent annually through 1993. (Consumer Summary produced by Reliance Medical Information, Inc.)

Patient outcomes, Mortality, Surveys, California, AIDS virus carriers, HIV carriers, AIDS-related complex, San Francisco

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Cocaine use and HIV infection in intravenous drug users in San Francisco

Article Abstract:

Risk factors for AIDS virus infection were studied in 633 heterosexual intravenous drug users. The rate of infection was 26 percent in blacks, 10 percent in Hispanics and 6 percent in whites. According to the results, the risk of AIDS virus infection increased slightly with intravenous cocaine use. In fact, a 35 percent seroprevalence was found in those subjects who used cocaine on a daily basis, and blacks were more likely to be daily cocaine users. A higher chance of infection was associated with black race, cocaine injection (especially on a daily basis, and among blacks and Hispanics), heavy cocaine use by blacks prior to methadone treatment and use of drugs in shooting galleries. (Methadone is a treatment for heroin and other drug addicts that relieves the body's craving without causing a high.) Methadone treatment was found to significantly reduce heroin use and somewhat reduce cocaine use. However, 24 percent of cocaine users receiving methadone began or increased cocaine injection after beginning treatment.

HIV (Viruses), HIV, Cocaine abuse, Injections, Intravenous, Intravenous injections

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