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Query: UMLS:C0019693 (HIV)
 170,526 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

In the past 5 yr, an increased incidence of tuberculosis has been noted in the United States. Simultaneously, the population infected with human immunodeficiency virus-type I (HIV-I) and the number of cases of acquired immunodeficiency syndrome (AIDS) have increased. Selected areas of the United States have also reported increases in the frequency of drug-resistant isolates of Mycobacterium tuberculosis. Because our institution serves a population in which tuberculosis, AIDS, and drug resistant isolates of M. tuberculosis are frequently encountered, we sought to better define interrelationships among these factors by retrospectively reviewing the demographic, clinical, bacteriologic, and radiologic data for all adult patients in whom M. tuberculosis was isolated from a culture of respiratory-tract secretions during a 1-year period (June 1, 1988 to May 31, 1989). Two hundred forty-six patients were thus identified; 66.5% were U.S. born blacks, and 62.6% were 17 to 40 yr of age. Risk factors for HIV infection were present in 106 patients. The overall resistance rate (one or more drugs) = 30.9%, with primary resistance = 22.6% (35 of 155) and secondary resistance = 49.2% (29 of 59). In addition, 12 resistant isolates were found in 32 patients whose prior treatment status was indeterminate. Of the resistant isolates, 56.6% (43 of 76) were multiply resistant. Isoniazid resistance was noted in 90.7% (69 of 76) and rifampin resistance was noted in 50% (38 of 76) of the resistant isolates. No significant differences in the overall frequency of resistance were noted in patients at risk for HIV infection compared with those without these risks.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Drug-resistant tuberculosis in an urban population including patients at risk for human immunodeficiency virus infection. 843 Sep 76

Approximately 25 percent of individuals exposed to Mycobacterium tuberculosis become infected. Of those, about 10 percent will develop clinically active tuberculosis at some time in their lives. The tuberculin skin test should be used to screen all patients, especially those at greatest risk of contracting the disease, such as the young and the old, and those with weakened immune systems from poor nutrition, alcohol and drug abuse, chronic illness and human immunodeficiency virus infection. Depending on the characteristics of the local population and individual medical risk factors, a reaction (induration) between 5 and 15 mm (or more) generally represents infection. Isoniazid therapy in persons with positive skin tests will decrease the risk of disease by 60 to 80 percent. Family physicians will play a critical role in efforts to eliminate tuberculosis from the United States by the year 2010.
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PMID:Return of tuberculosis: screening and preventive therapy. 199 Jul 30

The goal of modern therapy of tuberculosis is the rapid killing of all bacilli with potent and relatively atoxic antituberculous drugs. Currently available first-line drug regimens are highly effective, well tolerated and relatively easily administered. The addition of Pyrazinamide enables the minimum treatment period to be shortened to six months (two months Isoniazid, Rifampin, Pyrazinamide and four months Isoniazid, Rifampicin). This article reviews the available first-line drugs in treatment of tuberculosis, the rationale for the recommended chemotherapeutic regimens, the follow-up of treated patients and special issues related to the treatment of extrapulmonary tuberculosis and tuberculosis in HIV-infected patients.
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PMID:[Tuberculosis therapy 1990]. 219 Feb 95

The aim of primary prophylaxy against tuberculosis is to prevent new cases of infection. The diagnosis, early treatment and initial identification of patients with tuberculosis can decrease the risk of dissemination. Measures should be particularly severe in cases of multiresistant tuberculosis. Exposed subjects should be protected by BCG vaccination which reduces the risk of contamination by half. In particularly susceptible exposed subjects (children, immunodepressed subjects) separation is need and in certain cases chemoprophylaxy should be prescribed (small non-vaccinated children, HIV seropositive subjects). Isoniazid is classically recommended for 3 months. In case of multiresistant tuberculosis, other chemoprophylaxy protocols are proposed (ethambutol, pyrazinamide and ofloxacine). The aim of secondary chemoprevention of tuberculosis is to avoid tuberculosis infection from developing into full blown disease. Chemoprophylaxy is the only effective treatment. It is proposed after recent asymptomatic reactivation (newly positive tuberculin test) in children and immunodepressed patients. Chemoprophylaxis is based on isoniazid for 6 months. Other protocols are being evaluated in HIV positive patients. This secondary chemoprophylaxy is also proposed to subjects with tuberculosis sequellae and who are susceptible of becoming immunodepressed due to HIV infection or onset of an organ graft protocol. The presence of a resistant strain can modify management.
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PMID:[Prevention of tuberculosis]. 789 62

The treatment and prevention of tuberculosis in HIV-infected patients present significant new challenges. In patients with drug-susceptible organisms, treatment initially with three- and four-drug followed by two-drug regimens used for 6 to 9 months is efficacious, although there appears to be higher rates of adverse drug reactions than in HIV-negative patients. Treatment of MDR-TB is more difficult, requiring a high index of clinical suspicion and rapid detection and the use of multiple drugs with lower efficacy and greater toxicity than first-line agents. Directly observed therapy is the single most effective public health strategy to ensure completion of therapy and to prevent the emergence of drug-resistant tuberculosis. Isoniazid preventive therapy should be given to HIV-infected patients who are tuberculin positive and considered in selected patients who are anergic. There are many unresolved issues and future needs, including (1) the optimal regimen and duration of therapy for drug-sensitive tuberculosis; (2) the necessity for maintenance therapy following completion of a multidrug regimen; (3) an optimal regimen for treatment of MDR-TB; (4) the duration of isoniazid preventive therapy; (5) efficacy and duration of other preventive regimens, for example, pyrazinamide and rifampin; (6) the need for and choice of drugs for persons exposed to MDR-TB; (7) development of new antimycobacterial agents; and (8) the feasibility of some of these strategies in developing countries, which have the greatest burden of tuberculosis with HIV infection. Ongoing and future studies will address these questions to ultimately improve the treatment and prevention of tuberculosis in the HIV-infected patient.
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PMID:Treatment and prevention of tuberculosis in HIV-infected persons. 808 67

Tuberculosis occurring with human immunodeficiency virus (HIV) infection is a serious and growing public health problem. We have carried out a randomised clinical trial of a 12-month course of isoniazid plus vitamin B6 versus vitamin B6 alone in Port-au-Prince, Haiti, to assess the efficacy of isoniazid in preventing active tuberculosis in symptom-free HIV-infected individuals. The effect of prophylaxis on the development of HIV disease, AIDS, and death was also investigated. 118 subjects were assigned treatment with isoniazid plus B6 (n = 58) or B6 alone (n = 60) between 1986 and 1989. The treatment groups were similar at study entry in demographic, clinical, and immunological characteristics. Interim analysis in 1990 revealed no significant difference in tuberculosis outcome measures. Follow-up was continued until 1992, at which time significant protection by isoniazid against the development of tuberculosis was apparent, both for the whole study population and for subjects positive for purified protein derivative of tuberculin (PPD). The incidence of tuberculosis was lower in isoniazid recipients than in patients who received B6 alone (2.2 vs 7.5 per 100 person-years). The relative risk of tuberculosis was 3.4 (95% CI 1.1-10.6) for B6 alone versus isoniazid plus B6 (p < 0.05). Isoniazid also delayed progression to HIV disease and AIDS and death. Thus isoniazid effectively decreases the incidence of tuberculosis and delays the onset of HIV-related disease in symptom-free HIV-seropositive individuals. Isoniazid prophylaxis should be considered for HIV-seropositive, PPD-positive subjects, and may also be appropriate for PPD-negative patients in areas where tuberculosis is highly endemic.
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PMID:Effect of isoniazid prophylaxis on incidence of active tuberculosis and progression of HIV infection. 810 59

The number of drugs available for treatment and prevention of opportunistic infections in patients who are seropositive for HIV infection is limited, although some agents currently being studied show promise. Pneumocystis carinii pneumonia, the most common opportunistic infection, can be effectively managed, although prophylaxis must be continued indefinitely. Because an increased incidence of tuberculosis is associated with HIV infection, the emergence of strains that are resistant to multiple drugs is of concern. Intensive therapy with five or six drugs may be necessary. Isoniazid (Nydrazid) is recommended for prophylaxis.
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PMID:Opportunistic infections in AIDS patients. Current management and prevention. 827 2

We report the case of a 28-year-old-prostitute from Thailand with HIV infection stage B2 associated with retroperitoneal lymph node tuberculosis. 6 days after the beginning of anti-tuberculous therapy (isoniazid, rifampicin, pyrazinamid and ethambutol) the temperature rose to 40.5 degrees C, diarrhea, vomiting, and tachycardia developed and systolic blood pressure fell to 80 mm Hg. Liver function tests revealed acute hepatic failure (ALT 800 IU/l rising to 1500; serum bilirubin 89 mumol/l rising to 238.0; alkaline phosphatase 199 IU/l; glucose 1.8 mmol/l; prothrombin time 20%). Isoniazid, rifampicin, and pyrazinamid were replaced by streptomycin and PAS. A few days after withdrawal the liver profile returned to normal. Hours after the reintroduction of rifampicin total body erythema, pruritus, vomiting and severe hypotension developed, requiring saline methylprednisolone and epinephrine administration. The next reexposure to intravenous rifampicin produced a rash and was rapidly discontinued. Liver function tests remained normal. Later mild adverse reactions to streptomycin and pyrazinamid occurred, two drugs which had been well tolerated before. Subsequently the diagnosis of adrenal insufficiency was established. After initiation of steroid replacement (50 mg prednisolone) the antituberculous therapy with isoniazid, pyrazinamid and ethambutol was well tolerated. We conclude that the shock in this HIV-infected patient was either due to severe anaphylaxis to rifampicin or acute adrenal insufficiency ensuing on this drug. The reversible fulminant acute hepatic failure represents either an adverse effect of antituberculous drugs, especially hepatotoxic interactions of drug combinations, or an ischemic liver injury during hypotension caused by anaphylaxis. The case illustrates the complex nature of side effects of antituberculous drugs in HIV patients and their aggravation by adrenal insufficiency.
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PMID:[Fulminant, rapidly reversible hepatitis and life-threatening anaphylaxis following rifampicin in an HIV-positive female patient with latent adrenal cortex insufficiency]. 864 39

The prophylaxis of tuberculosis is cost-effective in that it prevents hospitalizations and eliminates the need for multidrug treatment of active disease. Isoniazid is recommended for the prophylaxis of tuberculosis in patients with human immunodeficiency virus infection who have a positive tuberculin skin test, who have a history of a positive skin test, who have been in close contact with a person who has active tuberculosis or who are at high risk for tuberculosis because of certain behaviors or situations. Other patients with an altered immune status may also benefit from preventive therapy for tuberculosis. Of the atypical mycobacterial infections, only Mycobacterium avium-intracellulare complex disease (MAC) in AIDS patients has been effectively prevented. Rifabutin is now recommended for adult patients with CD4 counts below 100 per mm3. To prevent the selection of resistant organisms, active tuberculosis must be excluded before prophylactic therapy for tuberculosis or MAC is initiated.
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PMID:Prophylaxis of mycobacterial infections in immunocompromised patients. 890 Mar 58

Tuberculosis is the most common opportunistic infection worldwide and is caused by the only readily transmissible pathogen among persons with HIV infection. If treatment is initiated promptly and is supervised appropriately, cure, fortunately, is highly likely. Isoniazid preventive therapy substantially reduces the risk of tuberculosis in persons with HIV infection. Of the nontuberculous mycobacteria, Mycobacterium avium complex (MAC) is the most frequent cause of disease; however, disseminated MAC disease usually is not seen until the CD4+ cell count is less than 50 cells/L. Newer agents, such as the macrolides and rifabutin, form the nucleus of treatment regimens and also are effective in preventing the disease.
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PMID:Mycobacterial complications of HIV infection. 901 72


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