RESUMO
We sought to determine the risk of acquired rifamycin resistant (ARR) tuberculosis associated with rifampin- versus rifabutin-based directly observed therapy and to assess the risk factors for relapse of tuberculosis. This observational cohort study included patients with culture-confirmed rifamycin-susceptible tuberculosis reported to the Baltimore City Health Department (Baltimore, MD) during the period of January 1993 through December 2001. Of the 407 patients, 108 (27%) were human immunodeficiency virus (HIV) seropositive, 161 (40%) were HIV seronegative, and 138 (34%) had an unknown serostatus. Three (2.8%) of 108 HIV-seropositive persons had ARR tuberculosis, compared with 0 of 299 persons with negative or unknown HIV serostatus (P=.02). Among HIV-seropositive patients, 3 (3.7%) of 81 who were treated with rifampin and 0 of 27 who were treated with rifabutin had ARR tuberculosis (P=.57). Among HIV-seropositive patients, the only risk factor for recurrent tuberculosis was a low median initial CD4+ T lymphocyte count (51 vs. 138 cells/mm3; P=.02). The median CD4+ T lymphocyte count among patients with ARR tuberculosis was 51 cells/mm3. ARR tuberculosis can occur with rifampin-based regimens, but in this study, the risk was not significantly higher than that for a rifabutin-based regimen.
Assuntos
Antituberculosos/uso terapêutico , Farmacorresistência Bacteriana , Rifamicinas/uso terapêutico , Tuberculose/tratamento farmacológico , Adulto , Idoso , Feminino , Infecções por HIV/complicações , Soronegatividade para HIV , Soropositividade para HIV , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva , Rifabutina/uso terapêutico , Fatores de Risco , Testes Sorológicos , Tuberculose/complicações , Tuberculose/virologiaAssuntos
Linfadenite/microbiologia , Mycobacterium bovis/isolamento & purificação , Tuberculose/diagnóstico , Tuberculose/microbiologia , Feminino , Humanos , Lactente , Linfonodos/microbiologia , Linfonodos/patologia , Linfadenite/tratamento farmacológico , Linfadenite/cirurgia , México , Pescoço/microbiologia , Pescoço/patologia , Viagem , Tuberculose/tratamento farmacológicoRESUMO
The mechanism of elite control of HIV-1 replication is not fully understood. While immunosuppression due to rituximab based chemotherapy has been associated with increased replication of HBV, CMV, and HIV-1, control of replication-competent HIV-1 was maintained in an elite controller/suppressor treated with a regimen that included vincristine, cyclophosphamide, prednisone, four rounds of plasmapheresis and ten cycles of rituximab. The data suggests that de-novo antibody responses do not play a significant role in the control of viral replication in these patients.