rifampin and Acquired-Immunodeficiency-Syndrome

A 52-year-old patient misdiagnosed with spinal tuberculosis was successfully diagnosed with Mycobacterium avium infection using metagenomic next-generation sequencing and cured with four-drug combination protocol chemotherapy (amikacin, rifampicin, clarithromycin, ethambutol) and spinal fixation.

Topics: Acquired Immunodeficiency Syndrome; Anti-Bacterial Agents; Clarithromycin; Drug Therapy, Combination; Humans; Middle Aged; Mycobacterium avium Complex; Mycobacterium avium-intracellulare Infection; Rifampin

Because of the increasing availability of antiretroviral (ARV) agents for HIV in low-income countries, many clinicians now need training on their use. This is especially true for clinicians caring for individuals with tuberculosis (TB), given its close relationship with HIV/AIDS. This article summarizes the key decisions facing clinicians who manage HIV-infected persons, with particular reference to issues regarding those dually infected with TB. Health care provider-initiated diagnostic testing using rapid HIV tests should be offered to all individuals with symptoms and signs suggesting HIV infection, including all persons with TB. Issues to be included in pre- and post-test counseling sessions are discussed. HIV-infected patients should be evaluated to determine clinical staging of HIV; certain laboratory examinations should ideally be performed to assess the degree of immunosuppression and to aid decisions about when best to start ARV therapy and preventive therapies. The recommended ARV regimens and guidance on proposed patient follow-up are presented. Good adherence to ARVs is required and factors that induce and reinforce compliance are suggested. The treatment of TB is a high priority, and follows the same principles whether the patient is HIV-infected or not. Suggestions are made about ARV use in patients with TB. A standardized and complementary information system should be developed to monitor management of HIV-TB patients and performance of joint TB and HIV care efforts. By diagnosing and managing additional HIV cases detected through the portal of the TB control programme, clinicians will contribute to diminishing the burden of HIV, and thus, TB.

Topics: Acquired Immunodeficiency Syndrome; AIDS-Related Opportunistic Infections; Anti-Retroviral Agents; Antibiotics, Antitubercular; Comorbidity; HIV Infections; Humans; Patient Compliance; Poverty Areas; Reverse Transcriptase Inhibitors; Rifampin; Tuberculosis

Tuberculosis and other mycobacterial diseases are frequent coinfections in AIDS patients with an increased related mortality. In this review we have updated the treatment of the main mycobacterial diseases (tuberculosis and Mycobacterium avium disease), under the scope of pharmacological interactions between antimycobacterial drugs, specially rifampicin and clarithromycin, and anti-retroviral drugs. Antimycobacterial treatment schemes, their duration, primary and secondary chemoprophylaxis and the optimal time to start the anti-retroviral therapy are analized. Finally, the immnune reconstitution inflammatory syndrome and its treatment are discussed.

Topics: Acquired Immunodeficiency Syndrome; AIDS-Related Opportunistic Infections; Anti-Bacterial Agents; Anti-Retroviral Agents; Clarithromycin; Drug Interactions; Humans; Mycobacterium Infections; Rifampin; Tuberculosis

Rhodococcus equi is an emerging opportunistic pathogen of HIV-I infected patients. It is an aerobic, Gram-positive coryneform bacterium which acts as a facultative intracellular micro-organism, multiplying in the phagosome of macrophages. Eighteen cases of R. equi infection in HIV-I positive patients have now been reported. Sixteen of these had pneumonia, of which 12 had cavitating lung lesions. A history of contact with farm animals, which are the primary hosts of R. equi, was found in only three patients. There was a delay in establishing a definite diagnosis in most cases as this depended upon the isolation of R. equi from sputum, bronchoalveolar lavage fluid, or blood. Treatment included surgical resection in five patients and erythromycin with a second antibiotic in 13 cases, but II of the 18 patients died from the infection. In this report we describe our experience of R. equi pneumonia in two AIDS patients and review the published cases of the disease in man.

Topics: Acquired Immunodeficiency Syndrome; Actinomycetales Infections; Adult; Amoxicillin; Amoxicillin-Potassium Clavulanate Combination; Clavulanic Acids; Doxycycline; Drug Therapy, Combination; HIV Seropositivity; HIV-1; Humans; Male; Microbial Sensitivity Tests; Pneumonia; Rhodococcus equi; Rifampin

Rhodococcus equi is an aerobic, gram-positive, non-motile pleomorphic bacillus infecting immunocompromised patients. Forty-nine cases of Rhodococcus equi infection have been reported, mainly in patients infected with the human immunodeficiency virus (HIV). A case in which Rhodococcus equi caused severe pulmonary infection, the most common presentation, is described. Clinically, patients have symptoms of pneumonia with hemoptysis as a prominent feature. X-ray will often show a cavitating upper-lobe infiltrate, resembling infection with mycobacteria. Rhodococcus equi is easily cultured from blood or sputum on standard media, but is frequently regarded as a contaminant. Mortality from Rhodococcus equi pneumonia is high (25%) and early surgical intervention has been recommended. Based on this review, the benefit of surgery seems dubious, whereas good results have been obtained using long-term antibiotic treatment with erythromycin plus rifampicin, or vancomycin in combination with either of these antibiotics.

Topics: Acquired Immunodeficiency Syndrome; Actinomycetales Infections; Adult; Drug Therapy, Combination; Erythromycin; Humans; Immunocompromised Host; Male; Pneumonia; Rhodococcus equi; Rifampin; Vancomycin

Two patients with a history of intravenous drug abuse developed a pancreatic abscess due to mycobacterial infection as their initial evident opportunistic infection in association with the acquired immunodeficiency syndrome (AIDS). This presentation of mycobacterial infection has been previously reported in nine patients. The two patients reported here are the second and third reported cases in association with AIDS. As this entity should be considered a cause of a pancreatic lesion in immunosuppressed patients, fluid drained from a pancreatic abscess should have histologic stains and cultures for mycobacteria.

Topics: Abscess; Acquired Immunodeficiency Syndrome; Adult; Amikacin; Female; Gentamicins; Humans; Isoniazid; Middle Aged; Mycobacterium Infections; Nafcillin; Pancreatic Diseases; Penicillins; Rifampin; Tomography, X-Ray Computed; Ultrasonography

Topics: Acquired Immunodeficiency Syndrome; Antitubercular Agents; Dermatitis; Humans; Lung Diseases; Lung Diseases, Obstructive; Lymphadenitis; Male; Mycobacterium Infections; Mycobacterium Infections, Nontuberculous; Nontuberculous Mycobacteria; Rifampin; Risk Factors; Tuberculin Test

Primary tuberculosis should be treated in all cases. In adults, the total treatment course for pulmonary tuberculosis can be shortened to 6 months. If the disease is not symptomatic, the rifampicin-isoniazid combination (10 mg/kg/day each) appears to be preferable to single drug therapy. In patients with symptomatic disease, pyrazinamide (30 mg/kg/day) should be added during the first 6-8 weeks and in some cases, corticosteroid therapy is also required. The drugs are usually well tolerated, but hepatic function should be monitored.

Topics: Acquired Immunodeficiency Syndrome; Drug Therapy, Combination; Ethambutol; Humans; Isoniazid; Pyrazinamide; Rifampin; Streptomycin; Tuberculosis

To compare the steady-state plasma and intrapulmonary concentrations of oral rifampicin (rifampin) in men and women with and without AIDS.. Prospective nonblinded pharmacokinetic study.. Ten men with AIDS, ten men without AIDS, ten women with AIDS, and ten women without AIDS.. Rifampicin 600 mg was administered orally once daily for 5 days to 40 adult volunteers. Blood was obtained 2 hours after the last dose and at the time of bronchoalveolar lavage (BAL) performed 4 hours after the last dose. Rifampicin was measured in plasma, epithelial lining fluid (ELF) and alveolar cells. Standardised BAL was performed without systemic sedation. The volume of ELF was calculated by the urea dilution method, and alveolar cells were recovered by a standardised centrifugation technique. The volume of alveolar cells was calculated from the cell count and differential performed on the BAL fluid. Rifampicin was measured by high-performance liquid chromatography.. Sex or AIDS status had no effect on plasma concentrations of rifampicin at 2 hours, 4 hours, or in ELF. Plasma concentrations (mean +/- SD) of rifampicin at 2 hours (9.15 +/- 5.4 mg/L) were not significantly different (p > 0.05) from those at 4 hours (9.10 +/- 5.6 mg/L) following the last dose. The ELF concentration was 2.0 +/- 1.6 mg/L with a range of 0-7.3 mg/L and the ELF/plasma ratio at 4 hours was 0.2 +/- 0.2. Rifampicin was not detectable in ELF in eight subjects (three with AIDS and five without AIDS) or in alveolar cells in three subjects without AIDS. There was no significant effect of AIDS on alveolar cell concentrations of rifampicin. Alveolar cell concentrations of rifampicin were significantly greater in women (13.9 +/- 6.7 mg/L) than in men (6.6 +/- 4.1 mg/L) [p = 0.0003]. Alveolar cell rifampicin concentrations were 78% greater in smoking women (17.8 +/- 7.0 mg/L) than in nonsmoking women (10.0 +/- 2.4 mg/L), but the difference was not significant (p > 0.05). CD4+ cell counts in the AIDS subjects were not correlated with the concentrations of rifampicin in plasma, ELF or alveolar cells.. The absorption of oral rifampicin was not affected by sex or AIDS. Plasma and alveolar cell concentrations were not significantly different, were both greater than ELF concentrations, and were adequate to inhibit Mycobacterium tuberculosis. Considerable interpatient variability was detected despite witnessed drug administration. The clinical significance of these findings is unknown but merits further investigation.

Topics: Acquired Immunodeficiency Syndrome; Administration, Oral; Antibiotics, Antitubercular; Female; Humans; Lung; Male; Prospective Studies; Pulmonary Alveoli; Respiratory Mucosa; Rifampin; Sex Factors; Tissue Distribution

To study the effect of rifampicin on the pharmacokinetics of fluconazole and on clinical outcomes of fluconazole treatment in patients with AIDS-related cryptococcal meningitis.. Forty Thai patients with AIDS and cryptococcal meningitis, of whom 20 had been receiving oral rifampicin for at least 2 weeks to treat tuberculosis.. Patients were treated for cryptococcal meningitis with amphotericin 0.7 mg/kg/day for 14 days followed by fluconazole 400 mg/day, which was reduced to 200 mg/day once culture of cerebrospinal fluid (CSF) became negative. Patients with tuberculosis received oral rifampicin 600 mg/day at night. Blood samples were collected from the first 12 patients in each group and pharmacokinetic parameters for fluconazole were calculated. CSF samples were collected by lumbar puncture and monitored for eradication of Cryptococcus neoformans.. Concomitant administration of rifampicin with fluconazole resulted in significant changes in the pharmacokinetic parameters of fluconazole, including a 39% increase in elimination rate constant, 28% shorter elimination half-life, 22% decrease in area under the concentration-time curve, 17% decrease in maximum concentration and 30% increase in clearance (p < 0.05). Different fluconazole regimens did not affect the extent of change in the elimination rate constant. Although serum concentrations of fluconazole during the time that patients received rifampicin concomitantly with fluconazole 200 mg/day were generally lower than the minimum inhibitory concentration for C. neoformans, there were no significant differences in clinical outcomes between the two groups to date (p = 0.792).. Coadministration of rifampicin with fluconazole caused significant changes in the pharmacokinetic parameters of fluconazole. Long-term monitoring for recurrence rates of cryptococcal meningitis is required to assess the clinical significance of this interaction.

Topics: Acquired Immunodeficiency Syndrome; Adult; Antibiotics, Antitubercular; Antifungal Agents; Area Under Curve; Chromatography, High Pressure Liquid; Cryptococcus neoformans; Drug Interactions; Female; Fluconazole; Half-Life; Humans; Male; Meningitis, Cryptococcal; Middle Aged; Rifampin; Spectrophotometry, Ultraviolet; Tuberculosis

Topics: Acquired Immunodeficiency Syndrome; Adult; AIDS-Related Opportunistic Infections; Antitubercular Agents; Desensitization, Immunologic; Dose-Response Relationship, Drug; Ethambutol; Female; Humans; Isoniazid; Male; Pyrazinamide; Rifampin; Stevens-Johnson Syndrome; Treatment Outcome; Tuberculosis

To determine the quantitative microbiologic response and the clinical response of patients with Mycobacterium avium complex bacteremia and AIDS to an oral antimycobacterial regimen.. A phase II, multicenter clinical trial.. Four university-affiliated medical centers.. Forty-one patients with HIV infection who had at least two consecutive blood cultures positive for M. avium complex and who had not received previous antimycobacterial therapy were enrolled in the study. Thirty-one patients were evaluable with regard to the efficacy of the oral regimen.. Patients received a combination of orally administered rifampin (600 mg), ethambutol (15 mg/kg body weight), clofazimine (100 mg once daily), and ciprofloxacin (750 mg twice daily) for 12 weeks. Parenterally administered amikacin, 7.5 mg/kg daily for 4 weeks after the first 4 weeks of oral therapy, was used at the discretion of the individual investigator.. Clinical symptoms, Karnofsky scores, and adverse events were monitored. Colony counts for M. avium complex were determined.. The mean logarithmic (log) baseline colony count decreased from 2.1 to 0.7 after 4 weeks of oral therapy (P less than 0.001). Suppression of bacteremia was sustained throughout therapy. Thirteen patients (42%) became culture negative during therapy. The mean duration of treatment was 9.7 weeks. Nineteen evaluable patients (61%) completed 12 weeks of therapy. Adverse reactions to one or more agents were common.. A rapid reduction in symptoms and bacteremia can be achieved as early as week 2 of therapy using an oral regimen of rifampin, ethambutol, clofazimine, and ciprofloxacin. Colony counts rose dramatically after therapy was discontinued, suggesting that more prolonged periods of therapy are necessary to eradicate systemic infection.

Topics: Acquired Immunodeficiency Syndrome; Administration, Oral; Adult; Amikacin; Anti-Infective Agents; Bacteremia; Ciprofloxacin; Clofazimine; Colony Count, Microbial; Drug Evaluation; Drug Therapy, Combination; Ethambutol; Female; Follow-Up Studies; Humans; Male; Middle Aged; Mycobacterium avium-intracellulare Infection; Prospective Studies; Rifampin

Disseminated Mycobacterium avium infection is common in patients with acquired immune deficiency syndrome (AIDS), but no drug studies have been reported establishing antimicrobial activity against this organism in a controlled, randomized trial. Clarithromycin, a new macrolide, has activity against M. avium in vitro and in animals, but it has not been studied in humans. In this randomized, double-blind, placebo-controlled trial, we measured the ability of clarithromycin to reduce M. avium bacteremia in patients with AIDS and disseminated infection. Of 23 patients initially enrolled, 15 men with late-stage AIDS qualified for the study. One group received clarithromycin alone for 6 wk, then placebo plus rifampin, isoniazid, ethambutol, and clofazimine for 6 wk. The other group received placebo alone, then clarithromycin plus the other four drugs. Colony-forming units (CFU) of M. avium per milliliter of blood were determined by quantitative cultures taken at baseline and every 2 wk thereafter. Minimum inhibitory concentration of clarithromycin for 90% of the strains isolated from patients at baseline, as measured on 7H11 agar at pH 6.6, was 8 micrograms/ml. Eight eligible patients with initial positive cultures who were initially receiving clarithromycin alone had marked declines in blood M. avium CFU; in six cases, CFU decreased to zero. When seven patients were switched to placebo plus the other four drugs, CFU rose in four patients and remained undetectable in three. The five eligible patients initially treated with placebo had progressive CFU increases; when three were switched to clarithromycin plus the four drugs, their CFU declined.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Acquired Immunodeficiency Syndrome; Adult; Clarithromycin; Colony Count, Microbial; Double-Blind Method; Drug Therapy, Combination; Erythromycin; Humans; Isoniazid; Microbial Sensitivity Tests; Mycobacterium avium Complex; Mycobacterium avium-intracellulare Infection; Rifampin

Human-immunodeficiency virus (HIV) infection is increasing worldwide and nontuberculous mycobacteria (NTM) is an established microbiologic cause of pulmonary disease, lymphadenitis, and disseminated disease in cases of advanced immune suppression. Data on patients coinfected with HIV and NTM are limited. Thus, this study aimed to analyze the clinical characteristics, drug resistance, and pathogen spectrum of patients coinfected with both HIV and NTM in the Chengdu area of China.. Data of 59 patients coinfected with both HIV and NTM collected from the Public Health Clinical Center of Chengdu, between January 2014 and December 2018, were analyzed. NTM drug sensitivity testing was performed using the microporous plate ratio method. Data were analyzed using SPSS 19.0, and the change in drug resistance rate was analyzed using the chi-square (χ) test.. Seven species/complex of NTM were identified from patients coinfected with HIV and NTM in this study, with Mycobacterium avium-intracellulare complex (52.5%) and M. kansasii (27.1%) as the predominant species. Male patients were more affected 50/59 (84.7%); the mean age of the 59 cases was 45 years. The clinical characteristics mainly included anemia (86.4%), cough and expectoration (79.7%). The baseline CD4 count was <50 cells/μL (84.7%). Patients were mainly in advanced acquired immunodeficiency syndrome (AIDS) stage. Chest imaging mainly showed patchy shadows (42.4%) and nodules (32.2%), with various degrees of AIDS-defining diseases. The drug resistance of NTM was severe, and the rate of isoniazid resistance (100.0%) was the highest, followed by rifampicin (94.9%), streptomycin (94.9%), ofloxacin (93.2%), and others. Ethambutol (52.5%) and clarithromycin (33.9%) were relatively low. No significant difference was found in the drug resistance rate of NTM strain against nine antituberculosis drugs in 5 years (P > 0.05).. The immune level of patients coinfected with HIV and NTM is low in advanced AIDS stage; more male are affected in patients who are mainly infected with MAC and M. kansasii and with serious drug resistance. The drug resistance rate of ethambutol and clarithromycin is relatively low.

Topics: Acquired Immunodeficiency Syndrome; Adult; Aged; Aged, 80 and over; Antitubercular Agents; China; Clarithromycin; Ethambutol; Female; HIV Infections; HIV-1; Humans; Isoniazid; Male; Middle Aged; Mycobacterium avium Complex; Nontuberculous Mycobacteria; Retrospective Studies; Rifampin; Streptomycin; Tuberculosis, Pulmonary; Young Adult

to determine the effect of a rifampicin-containing tuberculosis regimen on efavirenz plasma concentrations and viral load in HIV/AIDS-Tuberculosis infection patients who received efavirenz-based antiretroviral therapy.. plasma efavirenz concentrations and HIV viral load were measured in HIV/AIDS patients treated with 600 mg efavirenz-based antiretroviral for 3 to 6 months and in HIV/AIDS-Tuberculosis infection patients treated with similar antiretroviral regimen plus rifampicin-containing antituberculosis in Sulianti Saroso Infectious disease Hospital, Jakarta. Plasma efavirenz concentration in both groups were compared using Mann-Whitney test, while proportion of patients with viral load >40 copy/mL were analyzed with chi-square test.. forty five patients (27 with HIV/AIDS and 18 with HIV/AIDS-Tuberculosis infections) were recruited during the period of February to May 2015. The median efavirenz plasma concentration obtained from HIV/AIDS group was 0,680 mg/L(range 0,24 to 5,67 mg/L and that obtained from HIV/AIDS-Tuberculosis group was 0.685 mg/L (0.12 -2.23 mg/L) which was not significantly different statistically. The proportion of patients with viral load 40 copies/mL after 3-6 months of ARV treatment in the HIV/AIDS group was 51.9%, and in the HIV/AIDS-Tuberculosis group was 72.2%, which was not significantly different statistically (Chi Square test, p=0.291).. plasma efavirenz concentration in HIV/AIDS-tuberculosis patients receiving antiretroviral and rifampicin is not significantly different from that on HIV/AIDS patients without tuberculosis. Proportion of patients with viral load of >40 copy/mL is higher in HIV/AIDS-tuberculosis patients receiving rifampicin compared to HIV/AIDS patients that not receive rifampicin. However, this difference did not reach statistical significance. Confirmatory studies with bigger sample size are needed to clarify the influence of rifampicin on plasma level of efavirenzand and on viral load.

Topics: Acquired Immunodeficiency Syndrome; Adult; Alkynes; Anti-HIV Agents; Antibiotics, Antitubercular; Benzoxazines; CD4 Lymphocyte Count; Central Nervous System; Cyclopropanes; Female; Humans; Male; Middle Aged; Rifampin; Tuberculosis; Viral Load; Young Adult

Efavirenz (EFV) therapeutic response and toxicity are associated with high inter-individual variability attributed to variation in its pharmacokinetics. Plasma concentrations below 1 μg/ml may result in virologic failure and above 4 μg/ml, may result in central nervous system adverse effects. This study used population pharmacokinetics modeling to explore the influence of demographic and pharmacogenetic factors including efavirenz-rifampicin interaction on EFV pharmacokinetics, towards safer dosing of EFV.. Patients receiving an EFV-based regimen for their antiretroviral therapy and a rifampicin-containing anti-TB regimen were recruited. EFV plasma concentrations were measured by HPLC and genomic DNA genotyped for variants in the CYP2B6, CYP2A6 and ABCB1 genes. All patients were evaluated for central nervous system adverse effects characterised as sleep disorders, hallucinations and headaches using the WHO ADR grading system. A pharmacokinetic model was built in a forward and reverse procedure using nonlinear mixed effect modeling in NONMEM VI followed by model-based simulations for optimal doses.. CYP2B6*6 and *18 variant alleles, weight and sex were the most significant covariates explaining 55% of inter-individual variability in EFV clearance. Patients with the CYP2B6*6TT genotype had a 63% decrease in EFV clearance despite their CYP2B6*18 genotypes with females having 22% higher clearance compared to males. There was a 21% increase in clearance for every 10 kg increase in weight. The effect of TB/HIV co-treatment versus HIV treatment only was not statistically significant. No clinically relevant association between CYP2B6 genotypes and CNS adverse effects was seen, but patients with CNS adverse effects had a 27% lower clearance compared to those without. Model- based simulations indicated that all carriers of CYP2B6*6 TT genotype would be recommended a dose reduction to 200 mg/day, while the majority of extensive metabolisers may be given 400 mg/day and still maintain therapeutic levels.. This study showed that screening for CYP2B6 functional variants has a high predictability for efavirenz plasma levels and could be used in prescribing optimal and safe EFV doses.

Topics: Acquired Immunodeficiency Syndrome; Adult; Alkynes; Alleles; Anti-HIV Agents; ATP Binding Cassette Transporter, Subfamily B; Benzoxazines; Body Weight; Case-Control Studies; Cyclopropanes; Cytochrome P-450 CYP2A6; Cytochrome P-450 CYP2B6; Drug Interactions; Female; Hallucinations; Headache; Humans; Male; Models, Biological; Rifampin; Sex Characteristics; Sleep Wake Disorders; Tuberculosis; Zimbabwe

HIV/tuberculosis (HIV/TB)-coinfected patients intolerant/resistant to nonnucleoside reverse transcriptase inhibitors (NNRTIs) have limited treatment options. We evaluated the pharmacokinetics (PK)/safety/efficacy of an adjusted dose of indinavir/ritonavir (IDV/r) 600/100 mg plus two NRTIs in HIV/TB-coinfected Thais receiving rifampicin-based anti-TB treatment. This was a prospective, open-label study. Eighteen Thai, HIV/TB-coinfected patients between 18 and 60 years were recruited. IDV/r 600 mg/100 mg plus lamivudine and stavudine were administered every 12 h (bid). When rifampicin was stopped, IDV/r was reduced to 400/100 mg BID. Clinical outcomes, adverse events, and concomitant drugs were intensively collected. Intensive 12-h PK was performed after 2 weeks of IDV/r while on rifampicin. Samples were collected: predosing and 1, 2, 3, 4, 6, 8, 10, and 12 h after drug intake. The median body weight was 55 kg. The median CD4 was 26 cells/μl. The median HIV RNA was 5.05 log(10) copies/ml. Then 15/18 underwent intensive PK at week 2. The median time between initiating rifampicin and IDV/r was 4.5 months. The median duration of rifampicin during study (rifampicin/IDV/r together) was 15.6 weeks. All received a total of 9 months of antituberculous drugs. The geometric means (GM) of indinavir AUC(0-12) and C(12) were 8.11 mg*h/liter and 0.03 mg/liter, respectively. After stopping rifampicin and reducing IDV/r to 400/100 bid, the GM indinavir C(12) increased to 0.68 mg/liter (p=0.004). In all, 8/18 (44%) had asymptomatic ALT elevation and 2/18 (11%) had symptomatic hepatotoxicity requiring IDV/r discontinuation. All 13 patients who remained on IDV/r treatment had HIV RNA <50 copies/ml at 48 weeks. Concomitant use of rifampicin and IDV/r resulted in subtherapeutic indinavir concentrations. Although 44% of them developed asymptomatic Grade 3/4 transaminitis, the rate of study drug discontinuation due to hepatotoxicity was low. Despite good virological outcome in our cohort, prolonged exposure to subtherapeutic indinavir concentrations may lead to treatment failure.

Topics: Acquired Immunodeficiency Syndrome; Adult; Antibiotics, Antitubercular; CD4 Lymphocyte Count; Coinfection; Drug Administration Schedule; Drug Resistance, Viral; Drug Therapy, Combination; Female; HIV Protease Inhibitors; Humans; Indinavir; Male; Pilot Projects; Prospective Studies; Rifampin; Ritonavir; RNA, Viral; Thailand; Treatment Failure; Tuberculosis; Viral Load

Topics: Acquired Immunodeficiency Syndrome; Antibiotics, Antitubercular; Bacterial Proteins; Drug Resistance, Bacterial; Female; Genotype; Humans; Ill-Housed Persons; Microbial Sensitivity Tests; Middle Aged; Mutation; Mycobacterium tuberculosis; Oxidoreductases; Rifampin; Tuberculosis

The study was done to determine the anti-tuberculosis drug resistance patterns of Mycobacterium tuberculosis (MTB) in AIDS patients. Fifty antiretroviral drug naïve new AIDS patients with clinical evidence of pulmonary tuberculosis and no previous history of tuberculosis were recruited. Baseline CD4 counts and plasma viral loads (PVL) were measured by flow cytometry and RT-PCR, respectively. Sputum samples were obtained from each patient and subjected to Ziehl-Neelsen staining and cultured on Lowenstein-Jensen medium and using the BACTEC 460 system (B460). Antimicrobial susceptibilities were tested in all isolates using the B460 gystem. The occurrence of MTB was found to be more common with a PVL>4 log10 copies/ml (odds ratio: 4.6). Of 15 MTB isolates, 8 (53.3%) had single drug resistance, 4 (26.7%) had multidrug resistance (MDR) and 1 (6.7%) had resistance to three drugs (non-MDR). Two isolates (13.3%) were sensitive to all the four drugs. Resistance to first line anti-tuberculosis drugs was found to be higher among AIDS patients with MTB.

Topics: Acquired Immunodeficiency Syndrome; Adult; Anti-Bacterial Agents; Antitubercular Agents; CD4 Lymphocyte Count; Drug Resistance, Multiple, Bacterial; Ethambutol; Female; Humans; India; Isoniazid; Male; Mycobacterium tuberculosis; Reverse Transcriptase Polymerase Chain Reaction; Rifampin; Sputum; Streptomycin; Tuberculosis, Pulmonary; Viral Load

Mycobacterium tuberculosis infection has been shown to result in increased HIV replication and disease progression in HIV-infected individuals through increased immune activation. The objective of this study was to correlate plasma levels of immune activation markers with the presence of tuberculosis (TB) in HIV-infected and uninfected individuals, and to study the changes following anti-tuberculosis treatment.. Plasma markers of immune activation - neopterin, beta-2-microglobulin (beta2M) and soluble tumour necrosis factor alpha receptor type I (sTNFalpha-RI) were measured by ELISA in 42 HIV positive TB patients (HIV+TB+) undergoing a six-month course of TB chemotherapy. Thirty seven HIV+ persons without active TB, 38 TB patients without HIV infection, and 62 healthy volunteers served as controls.. Plasma levels of all three markers were elevated in HIV+ individuals, more so in those with active TB. When HIV+ individuals were further categorized based on CD4+ T cell counts, HIV+TB+ patients with CD4+ T cells counts

Topics: Acquired Immunodeficiency Syndrome; Analysis of Variance; beta 2-Microglobulin; Biomarkers; CD4-Positive T-Lymphocytes; Cell Count; Enzyme-Linked Immunosorbent Assay; Ethambutol; Humans; India; Isoniazid; Neopterin; Pyrazinamide; Receptors, Tumor Necrosis Factor, Type I; Rifampin; Tuberculosis

Abstract A 27-year-old man admitted for high fever, wet cough and abnormality on his chest radiograph. He was diagnosed as pulmonary tuberculosis, and started treatment with INH, RFP, EB, and PZA. After other examinations, he was diagnosed as having a acquired immunodeficiency syndrome, too. We gave him zidovudine and lamivudine/ abacavir sulfate to treat HIV infection. After starting treatment with anti-tuberculosis drugs his fever alleviated, but after 10 days from the start of anti-HIV drugs, he showed high fever, and abnormality of his chest radiograph exacervated. We diagnosed him as immune reconstitution syndrome, and gave him prednisolone 30 mg/day. His symptoms improved gradually.

Topics: Acquired Immunodeficiency Syndrome; Adult; Anti-HIV Agents; Antitubercular Agents; Drug Therapy, Combination; Ethambutol; HIV-1; Humans; Isoniazid; Male; Pyrazinamide; Rifampin; Tuberculosis, Pulmonary; Zidovudine

Bacillary angiomatosis is an opportunistic bacterial infection caused by either Bartonella henselae or B. quintana. The classic histologic presentation of bacillary angiomatosis involves three components: a lobular proliferation of capillaries with enlarged endothelial cells, neutrophilic debris, and clumps of finely granular material identified as bacteria with staining techniques. Pseudoepitheliomatous hyperplasia is a histologic reaction pattern characterized by epithelial proliferation in response to a variety of stimuli, including mycobacterial, fungal, and bacterial infections. We describe a case of bacillary angiomatosis associated with pseudoepitheliomatous hyperplasia in an immunocompromised patient with Acquired Immunodeficiency Syndrome. Histologic examination of a finger lesion demonstrated a capillary proliferation with neutrophilic debris and characteristic amorphous granular deposits. Warthin-Starry and Giemsa staining revealed clumps of coccobacilli. Cervical lymph node tissue also revealed organisms identified as Bartonella with PCR techniques. Stains and cultures for acid fast bacilli, fungus, and bacteria were negative. To our knowledge, there has been only one other report of bacillary angiomatosis presenting with pseudoepitheliomatous hyperplasia. We conclude that the differential diagnosis of entities associated with pseudoepitheliomatous hyperplasia should be expanded to include bacillary angiomatosis.

Topics: Acquired Immunodeficiency Syndrome; AIDS-Related Opportunistic Infections; Angiomatosis, Bacillary; Anti-Bacterial Agents; Bartonella; DNA, Bacterial; Doxycycline; Drug Therapy, Combination; Epidermis; Fingers; Humans; Hyperplasia; Immunocompromised Host; Lymph Nodes; Male; Middle Aged; Ofloxacin; Rifampin; Treatment Outcome

Topics: Acquired Immunodeficiency Syndrome; Antibiotics, Antitubercular; Drug Therapy, Combination; HIV Protease Inhibitors; Humans; Rifampin; Saquinavir; Treatment Outcome; Tuberculosis

The Rhodococcus equi is an aerobic gram positive pleomorphic bacillus, that was isolated for the first time like a producer of bronchopneumonia in young horses. Every time more often, it is being recognized as a pathogen in humans, mainly in the immunodepressed population. We described a case, until now exceptional, of laryngeal infection by Rhodococcus equi in a patient with positive serology for the virus of the human immunodeficiency (HIV), and we reviewed some clinical and epidemiological characteristics of the infections by this germ. The treatment is riphampicine and/or erythromycin, being the prognosis bad, because usually they are immunodepressed patients.

Topics: Acquired Immunodeficiency Syndrome; Actinomycetales Infections; Adult; Anti-Bacterial Agents; Antibiotics, Antitubercular; Drug Therapy, Combination; Erythromycin; Humans; Laryngeal Mucosa; Laryngitis; Male; Rhodococcus equi; Rifampin

In developing countries, there is little information about the risk factors that predict noncompliance with tuberculosis (TB) treatment in hospitals.. This study analyzes possible factors associated with noncompliance with TB treatment among patients treated at HAA.. A retrospective cohort study was made including all patients who initiated TB treatment at HAA, from January to December 1998. A standard form was used to review medical records and to collect data on each patient. This data was evaluated in comparison with data from the state TB control program.. Of the 341 patients included in the study, 186 (61.2%) were considered cured and 67 (22%) were non-compliant. The factors associated with noncompliance were: previous anti-TB treatment (RR = 1.95, 95% CI 1.29 to 2.93), prescription of drugs other than the standard first-line regimen proposed by the Brazilian Health Ministry (Rifampin + Isoniazide + Pyrazinamide) (RR = 0.54, 95% CI 0.35 to 0.83), the need for hospitalization (RR = 2.19, 95% CI 1.46 to 3.29) and non-inclusion in the hospital s TB Control Program for treatment follow up (RR = 0.54, 95% CI 0.35 to 0.82).. Anuar Auad Hospital (HAA) Goiânia, Goiás, Brazil.. Our results indicate the importance of establishing Tuberculosis Control Programs in hospitals, while paying special attention to patients with risk factors for noncompliance with TB treatment.

Topics: Acquired Immunodeficiency Syndrome; Adolescent; Adult; Aged; Antitubercular Agents; Brazil; Child; Child, Preschool; Female; Hospitals; Humans; Infant; Infant, Newborn; Isoniazid; Male; Medical Records; Middle Aged; Patients; Pyrazinamide; Rifampin; Risk Factors; Treatment Refusal; Tuberculosis

To assess the frequency of resistance of Mycobacterium tuberculosis to antituberculosis drugs and the factors associated with it among patients with tuberculosis (TB) and acquired immunodeficiency syndrome (AIDS).. The medical records of TB and AIDS cases diagnosed from 1992 to 1997 in a public service for AIDS care were reviewed.. Resistance was diagnosed in 82 (19%) of 431 cases. The mean and median values between the diagnosis of AIDS and the diagnosis of TB were 214.8 days and 70.5 days, respectively. Multidrug-resistant TB (MDR TB) occurred in 11.3% of cases. Of the 186 patients with no previous treatment, 13 (6.9%) presented primary MDR TB. Of the 90 cases with previous treatment, six (6.7%) presented monoresistance to rifampin and 27 (30%) presented MDR TB. The distribution of cases with sensitive and resistant M. tuberculosis strains was homogeneous in terms of the following variables: gender, age, category of exposure to human immunodeficiency virus (HIV), alcoholism, and homelessness. Multivariate analysis showed an association between resistance and the two following variables: previous treatment and duration of AIDS prior to TB exceeding 71 days. The rates of primary multiresistance and of monoresistance to rifampin were higher than those detected in HIV-negative patients in Brazil.. In this patient series, M. tuberculosis resistance was predominantly of the acquired type, and resistance was independently associated with previous treatment for TB and with duration of AIDS prior to TB exceeding 71 days.

Topics: Acquired Immunodeficiency Syndrome; Adult; AIDS-Related Opportunistic Infections; Antibiotics, Antitubercular; Antitubercular Agents; Brazil; Community Health Centers; Confidence Intervals; Drug Resistance, Microbial; Drug Resistance, Multiple; Female; Humans; Male; Middle Aged; Mycobacterium tuberculosis; Odds Ratio; Rifampin; Time Factors; Tuberculosis

The in vitro activities of three antifungal drugs alone and in combination were evaluated against five isolates of Cryptococcus neoformans using time-kill curves (TKC). The isolates were from AIDS patients who had either died or had failed to show a clinical response during amphotericin B (AMB) treatment. AMB, fluconazole (FCZ) and flucytosine (5FC), and combinations of the drugs (AMB plus 5FC, AMB plus rifampicin (RIF) and FCZ plus 5FC), were evaluated. With all five isolates AMB did not show fungicidal activity; instead, a persistent or tolerant effect was observed. Combinations of AMB plus 5FC and AMB plus RIF showed a clear synergic effect, except for one isolate tested with AMB plus RIF. In contrast, the FCZ plus 5FC combination did not inhibit growth of any isolate.

Topics: Acquired Immunodeficiency Syndrome; Amphotericin B; Antifungal Agents; Cryptococcosis; Cryptococcus neoformans; Drug Interactions; Drug Resistance, Microbial; Fluconazole; Flucytosine; Humans; Leprostatic Agents; Rifampin; Time Factors

Topics: Acquired Immunodeficiency Syndrome; AIDS-Related Opportunistic Infections; Antibiotics, Antitubercular; Cephalexin; Cephalosporins; Child; Female; Humans; Immunocompromised Host; Lymph Nodes; Pathology; Rifampin; Staphylococcal Infections; Staphylococcus aureus; Treatment Outcome

We reported a human immunodeficiency virus type 1-infected patient with a small solitary pulmonary nodule mimicking adenocarcinoma, who was treated successfully with antituberculosis therapy. We believe that high-resolution CT scans of thorax are important examinations to detect pulmonary inflammatory findings, such as ectasis of the bronchi leading to the nodules and calcifications in the nodules, and also as follow-up tests for evaluating effectiveness of treatment on pulmonary inflammatory nodules in human immunodeficiency virus type 1-infected patients.

Topics: Acquired Immunodeficiency Syndrome; Adenocarcinoma; Adult; Antitubercular Agents; Diagnosis, Differential; Drug Therapy, Combination; Ethambutol; HIV-1; Humans; Isoniazid; Lung Neoplasms; Male; Pyrazinamide; Rifampin; Solitary Pulmonary Nodule; Tomography, X-Ray Computed

Hypersensitivity reactions to rifampin are relatively uncommon, but they may result in cessation of therapeutic medications.. We report our experience with oral desensitization protocol to rifampin in a group of 35 HIV-positive patients with mycobacterial disease who had some hypersensitivity reaction to this drug.. Adverse reactions with this protocol were few and easily treated.. Oral desensitization to rifampin is safe and effective, allowing some of these patients (60%) to reintroduce the drug and to reduce the time of treatment.

Topics: Acquired Immunodeficiency Syndrome; Adult; Antibiotics, Antitubercular; Desensitization, Immunologic; Drug Hypersensitivity; Female; Humans; Male; Rifampin; Tuberculosis

Case reports of low serum concentrations of antituberculosis drugs, with resultant treatment failure and emergence of drug-resistant organisms in patients with the acquired immune-deficiency syndrome (AIDS), have prompted suggestions that therapeutic drug monitoring (TDM) may be indicated in patients co-infected with the human immunodeficiency virus (HIV) and Mycobacterium tuberculosis.. To test whether the bioavailability of antituberculosis drugs is altered in HIV-infected patients with tuberculosis.. Twenty-seven hospitalized tuberculosis patients (13 with AIDS, 14 HIV-negative) were entered into a pharmacokinetic trial. Following the supervised administration of standardized doses of isoniazid, rifampicin and pyrazinamide, the plasma concentrations of the drugs were measured repeatedly over 12 hours and the following parameters were derived for each agent: maximum measured drug concentration (Cmax), time-to-maximum measured drug concentration (Tmax) and area-under-the-concentration-time curve to 12 hours (AUC).. No significant differences emerged between the two groups in Cmax, Tmax, and AUC for isoniazid and pyrazinamide. For rifampicin the AIDS patients showed a greater AUC (P < 0.01) than the controls, but there were no significant differences in Cmax and Tmax.. There was no evidence that HIV infection reduced the plasma concentrations of antituberculosis drugs.

Topics: Absorption; Acquired Immunodeficiency Syndrome; Adolescent; Adult; Antitubercular Agents; Biological Availability; Female; Humans; Isoniazid; Male; Middle Aged; Pyrazinamide; Rifampin; Tuberculosis

From December 1992 to February 1993, 104 newly diagnosed pulmonary tuberculosis patients were enrolled in a prospective cohort study to assess the response to the 6 month-short-course regimen implemented in Cote d'Ivoire. This treatment encompassed the daily intake of Rifampicin and Pyrazinamide for 2 months followed by Rifampicin and Isoniazid for the remaining 4 months. All the patients were enrolled at the Treichville Tuberculosis Treatment Centre in Abidjan, and a follow-up of 6 months was observed for each patient. All in all, 41 patients were HIV-positive whereas 63 where HIV-negative. No statistical difference was noted between HIV-positive and HIV-negative patients with regard to the completion of therapy (85% versus 87%). The cure rate after an effective 6 month-therapy was similar among HIV-positive and HIV-negative patients (83% versus 84%) as well as the treatment failure rate which was 2.4% and 3% respectively. The results clearly indicate that the 6 month-short-course regimen policy implemented in Côte d'Ivoire is as effective for the treatment of HIV-associated tuberculosis as for the treatment of tuberculosis.

Topics: Acquired Immunodeficiency Syndrome; Adolescent; Adult; Antitubercular Agents; Cohort Studies; Cote d'Ivoire; Female; Humans; Isoniazid; Male; Middle Aged; Prospective Studies; Pyrazinamide; Rifampin; Tuberculosis

All New York City patients whose cultures yielded Mycobacterium tuberculosis with isolated resistance to rifampin in 1993 and 1994 were included in this study. Of the 96 patients, 48 (50%) had primary resistance, 32 (33%) had acquired resistance, and 16 (17%) had unclassified resistance; 66% had histories of illicit drug use, and 79% were infected with human immunodeficiency virus (HIV). The median time to emergence of resistance was 40 weeks among the 32 patients with acquired resistance. Each of the HIV-infected patients with acquired resistance (cases, n = 29) was matched to two HIV-infected patients who had disease due to fully susceptible M. tuberculosis (controls, n = 58). In multivariate analysis, factors associated with the emergence of rifampin resistance were as follows: a sputum smear positive for acid-fast bacilli, advanced immunosuppression, and nonadherence to therapy.

Topics: Acquired Immunodeficiency Syndrome; Adolescent; Adult; Aged; Antibiotics, Antitubercular; Drug Resistance, Microbial; Female; Humans; Male; Middle Aged; Mycobacterium tuberculosis; New York City; Rifampin; Tuberculosis

Patients with non-tuberculous mycobacteria are usually started on conventional antituberculous triple therapy once acid fast bacilli are detected, before the exact type of mycobacteria has been identified. The ability to identify the characteristics of patients with tuberculous and non-tuberculous mycobacteria may be helpful in identifying before treatment those patients more likely to have non-tuberculous infection.. A retrospective study was conducted of all patients in one unit in whom non-tuberculous mycobacteria were identified in sputum or bronchoalveolar washings in the period 1987-93. The pattern of drug resistance was determined from laboratory records, and all case notes and chest radiographs were reviewed to identify the underlying disease and treatment outcome. All cases were compared with a matched control group of patients with culture positive Mycobacterium tuberculosis diagnosed during the same period.. In the period studied there were 70 non-tuberculous and 221 tuberculous isolates. The non-tuberculous bacteria were typed as follows: M xenopi 23 (33%), M kansasii 19 (27%), M fortuitum 14 (20%), others 14 (20%). Of those with non-tuberculous mycobacteria, 83% were white subjects compared with 47% for tuberculosis. Patients with non-tuberculous mycobacteria were older than those with tuberculosis. Pre-existing lung disease or AIDS was present in 81% of patients with non-tuberculous mycobacteria and in 17% of patients with tuberculosis. Sensitivity to rifampicin and ethambutol was seen in 95% of M xenopi and 96% of M kansasii isolates. Relapse occurred in 60% of cases infected with M xenopi, 20% infected with M kansasii, and in 7% of cases with tuberculosis.. In the population studied non-tuberculous mycobacteria occurred most frequently in elderly white subjects with pre-existing lung disease. If mycobacteria are detected in this group, consideration should be given to the possibility of non-tuberculous infection before embarking on treatment. A combination containing rifampicin and ethambutol is effective. The relapse rate for infection with M xenopi is high and prospective studies of the effect of the above combination of antituberculosis drugs are needed.

Topics: Acquired Immunodeficiency Syndrome; Adolescent; Adult; Age Factors; Aged; Aged, 80 and over; Antibiotics, Antitubercular; Antitubercular Agents; Child; Drug Resistance; Drug Therapy, Combination; Ethambutol; Female; Humans; Lung Diseases; Male; Middle Aged; Mycobacterium Infections, Nontuberculous; Nontuberculous Mycobacteria; Retrospective Studies; Rifampin; Treatment Outcome; Tuberculosis, Pulmonary

Atypical clinical manifestations and rapid progression of tuberculous disease (TB) are well-recognized in adults with the acquired immunodeficiency syndrome (AIDS). There are few reports of children with AIDS and TB. We report the manifestations, clinical course and outcome of 12 pediatric patients with AIDS and TB.. The charts of all children admitted to our institution, from 1989 through 1994, with the diagnoses of AIDS and culture-proved TB were reviewed.. Twelve children between the ages of 2 months and 13 years fit the criteria. The mean time between the diagnosis of AIDS and TB was 20 months. The most frequent presenting symptoms were fever (75%) and tachypnea (33%). All had negative Mantoux tests (5 tuberculin units of purified protein derivative). Extrapulmonary TB was present in 3 (25%). A source case was identified for 4 (33%). Previous pulmonary disease was present in 7 (58%). Chest roentgenograms were abnormal in 11 (91%), with diffuse interstitial infiltration the most common finding. Susceptibility tests were performed on 10 strains, 3 of which were resistant to 1 or more antituberculosis drugs. Three patients (25%) died of TB, 1 of whom was appropriately treated with antituberculosis drugs but had a strain resistant to isoniazid and rifampin.. Children with AIDS and TB most frequently present with atypical manifestations of TB. A high index of suspicion is needed to correctly diagnose TB in this group of children. Early diagnosis is important because most respond well when treated appropriately.

Topics: Acquired Immunodeficiency Syndrome; Adolescent; AIDS-Related Opportunistic Infections; Antibiotics, Antitubercular; Antitubercular Agents; Capreomycin; Child; Child, Preschool; Ethambutol; Female; Humans; Infant; Isoniazid; Male; Microbial Sensitivity Tests; Pyrazinamide; Rifampin; Tuberculosis, Multidrug-Resistant; Tuberculosis, Pulmonary

Topics: Acquired Immunodeficiency Syndrome; Adult; AIDS-Related Opportunistic Infections; Anti-Bacterial Agents; Antibiotics, Antitubercular; Drainage; Erythromycin; Humans; Male; Mastoiditis; Rhodococcus equi; Rifampin

In order to determine the possible relationship among HIV patients coinfected with multidrug resistant tuberculosis strains who had been receiving clinical assistance in our Hospital, clinical and epidemiological information from 28 patients was collected. DNA fingerprinting by restriction fragment length polymorphism (RFLP) pattern was performed on the mycobacterial isolates from these patients, using the restriction enzyme Pvull and IS 6110 as genetic marker. A unique RFLP pattern was found in 10 isolates from 10 different patients who had a disease caused by a single strain. Our findings confirm RFLP as a reliable and useful tool to analyze TB transmission.

Topics: Acquired Immunodeficiency Syndrome; Adult; Argentina; Disease Outbreaks; DNA Fingerprinting; DNA, Bacterial; Female; Humans; Isoniazid; Male; Middle Aged; Mycobacterium tuberculosis; Polymorphism, Restriction Fragment Length; Rifampin; Tuberculosis, Multidrug-Resistant; Tuberculosis, Pulmonary

Multidrug-resistant tuberculosis has emerged over the last two years at Carrasco Hospital, located in Rosario city. Nosocomial transmission among 7 AIDS patients admitted into the same ward between June and December/94 was supported by temporal clustering of cases, matching drug susceptibility, and identical IS6110 fingerprints. Among 8 non-HIV chronic cases without evidence of reciprocal contact outside the hospital, two additional clusters of 2 and 4 cases, respectively, were identified. The latter was found to be generated by a strain genetically related to the one that infected AIDS patients. It is hypothesized that an ancestor strain, common to both, might have been brought into the hospital long before the outbreak was first suspected.

Topics: Acquired Immunodeficiency Syndrome; Adult; Argentina; Chronic Disease; Cross Infection; DNA Fingerprinting; DNA, Bacterial; Ethambutol; Humans; Isoniazid; Mycobacterium tuberculosis; Polymorphism, Restriction Fragment Length; Rifampin; Streptomycin; Tuberculosis, Multidrug-Resistant; Tuberculosis, Pulmonary

Topics: Acquired Immunodeficiency Syndrome; Argentina; Female; Humans; Isoniazid; Male; Rifampin; Tuberculosis, Multidrug-Resistant; Tuberculosis, Pulmonary

Tuberculosis of the liver is common in patients with acquired immunodeficiency syndrome (AIDS). Tuberculous liver granulomas in such patients are usually atypical. The liver granulomas may be even totally absent, but liver tissue usually reveals numerous acid-fast bacilli. Focal tuberculosis of the liver is a less common form of liver tuberculous infection. We present a 33-year old white homosexual man infected with the human immunodeficiency virus. He had three tumour-like lesions in the left liver lobe, which were subsequently diagnosed as focal hepatic tuberculosis with local hemorrhage. This unusual presentation of liver tuberculosis indicates the necessity of an aggressive diagnostic approach for the evaluation of focal liver lesions in patients with AIDS.

Topics: Acquired Immunodeficiency Syndrome; Adult; Ethambutol; Granuloma; Histocytochemistry; Homosexuality, Male; Humans; Isoniazid; Liver; Male; Mycobacterium; Pyrazinamide; Rifampin; Tuberculosis

Results from recent studies are shedding light on ways to prevent and treat Mycobacterium avium Complex (MAC) disease, a leading cause of death for people with AIDS. A two-drug combination treatment appears to be best. The Food and Drug Administration (FDA) has approved three drugs for the treatment of MAC disease: rifabutin (Mycobutin), clarithromycin (Biaxin), and azithromycin (Zithromax). Two studies using clarithromycin show promising results and indicate that clarithromycin is superior to rifabutin. Another study comparing azithromycin to rifabutin and then to a combination of the two showed azithromycin to be comparable to rifabutin, and the combination was significantly better than either drug alone. Other data show both rifabutin and clarithromycin have drug interactions with some, if not all, of the available protease inhibitors. Azithromycin has no known drug interactions with protease inhibitors and may be attractive for those taking a protease inhibitor. Many drug interactions are appearing so patients need to use caution when using rifabutin. Studies have shown that the optimum treatment for MAC disease is clarithromycin and ethambutol; the addition of clofazimine does not result in any additional benefit. Higher doses of clarithromycin (1000 mg twice a day) over the approved dose levels have proven to be life-threatening. Although the MAC treatment recommendations are to use either azithromycin or clarithromycin with ethambutol, azithromycin is not approved by the FDA for this use, despite many physicians' beliefs that azithromycin is as effective as clarithromycin for treating MAC.

Topics: Acquired Immunodeficiency Syndrome; Amikacin; Antitubercular Agents; Ciprofloxacin; Clarithromycin; Clofazimine; Drug Interactions; Drug Therapy, Combination; Ethambutol; Humans; Mycobacterium avium-intracellulare Infection; Rifabutin; Rifampin; Tuberculin Test; Zidovudine

Topics: Acquired Immunodeficiency Syndrome; Humans; Isoniazid; Microbial Sensitivity Tests; Rifampin; Streptomycin; Tuberculosis, Pulmonary

Topics: Acquired Immunodeficiency Syndrome; Actinomycetales Infections; Adult; Clarithromycin; Erythromycin; Humans; Imipenem; Male; Middle Aged; Pneumonia; Rhodococcus equi; Rifampin; Vancomycin

We describe a case of recurrent Stomatococcus mucilaginosus lower respiratory tract infection in a patient with AIDS. Apart from S. mucilaginosus no other pathogens were found to account for infection. There was a rapid response to rifampicin, the organism being resistant to penicillin, co-trimoxazole and ciprofloxacin. Infections caused by this organism are increasingly described, but there are few reports of lower respiratory tract infection.

Topics: Acquired Immunodeficiency Syndrome; Adult; AIDS-Related Opportunistic Infections; Gram-Positive Cocci; Humans; Male; Respiratory Tract Infections; Rifampin

Topics: Acquired Immunodeficiency Syndrome; Adult; AIDS-Related Opportunistic Infections; Bacteremia; Drug Resistance, Microbial; Humans; Male; Rifabutin; Rifampin; Staphylococcal Infections; Staphylococcus aureus; Staphylococcus epidermidis

In the past decade the incidence of tuberculosis has increased nationwide and more than doubled in New York City, where there have been recent nosocomial outbreaks of multidrug-resistant tuberculosis.. We collected information on every patient in New York City with a positive culture for Mycobacterium tuberculosis during April 1991. Drug-susceptibility testing was performed at the Centers for Disease Control and Prevention.. Of the 518 patients with positive cultures, 466 (90 percent) had isolates available for testing. Overall, 33 percent of these patients had isolates resistant to one or more antituberculosis drugs, 26 percent had isolates resistant to at least isoniazid, and 19 percent had isolates resistant to both isoniazid and rifampin. Of the 239 patients who had received antituberculosis therapy, 44 percent had isolates resistant to one or more drugs and 30 percent had isolates resistant to both isoniazid and rifampin. Among the patients who had never been treated, the proportion with resistance to one or more drugs increased from 10 percent in 1982 through 1984 to 23 percent in 1991 (P = 0.003). Patients who had never been treated and who were infected with the human immunodeficiency virus (HIV) or reported injection-drug use were more likely to have resistant isolates. Among patients with the acquired immunodeficiency syndrome, those with resistant isolates were more likely to die during follow-up through January 1992 (80 percent vs. 47 percent, P = 0.02). A history of antituberculosis therapy was the strongest predictor of the presence of resistant organisms (odds ratio, 2.7; P < 0.001).. There has been a marked increase in drug-resistant tuberculosis in New York City. Previously treated patients, those infected with HIV, and injection-drug users are at increased risk for drug resistance. Measures to control and prevent drug-resistant tuberculosis are urgently needed.

Topics: Acquired Immunodeficiency Syndrome; Adolescent; Adult; Antitubercular Agents; Centers for Disease Control and Prevention, U.S.; Drug Resistance, Microbial; Female; Health Surveys; HIV Infections; Humans; Isoniazid; Male; Microbial Sensitivity Tests; Middle Aged; Mycobacterium tuberculosis; New York City; Rifampin; Substance Abuse, Intravenous; Tuberculosis; Tuberculosis, Pulmonary; United States

Thirty-six consecutively observed HIV-seropositive patients with tuberculosis, including 31 patients with AIDS, who received antituberculous treatment, were followed up to evaluate its efficacy. Treatment with standard antituberculous regimens was intended except when an individual's condition required a modified therapeutic approach. Therapeutic failure occurred in five patients (14%) while on treatment, one also had a post-treatment relapse. Treatment failure was associated with drug resistance and non-compliance in three patients and in another two, both of whom died early in the course of their disease, with HIV-related conditions other than tuberculosis. The median relapse-free post-treatment follow-up time in 24 patients in whom treatment did not fail was 13 months (range 4-67). Standard antituberculous treatment is highly effective in the immediate and long-term treatment of HIV-related tuberculosis provided that drug susceptibility and treatment compliance are confirmed.

Topics: Acquired Immunodeficiency Syndrome; Adult; Aged; Antitubercular Agents; Bisexuality; CD4-CD8 Ratio; Ethambutol; Female; HIV Seropositivity; Homosexuality; Humans; Isoniazid; Male; Middle Aged; Mycobacterium tuberculosis; Rifampin; Time Factors; Treatment Failure; Treatment Outcome; Tuberculosis

Topics: Acquired Immunodeficiency Syndrome; Adult; Clofazimine; Drug Interactions; Humans; Male; Phenytoin; Rifampin

A man with AIDS and M. kansasii lung infection received rifampicin and isoniazid for 9 months, combined with ethambutol for four months. The treatment was effective with sputum culture negativation, but relapse occurred. The minimal inhibitory concentration of rifampicin for the M. kansasii strain was respectively 0.2 microgram/ml at the onset and 128 micrograms/ml after the treatment, giving evidence of acquired resistance. A new treatment was initiated but is was ineffective.

Topics: Acquired Immunodeficiency Syndrome; Adult; Drug Resistance, Microbial; Humans; Male; Mycobacterium Infections, Nontuberculous; Nontuberculous Mycobacteria; Recurrence; Rifampin; Tomography, X-Ray Computed; Tuberculosis, Pulmonary

Topics: Acquired Immunodeficiency Syndrome; Actinomycetales Infections; Adult; Anti-Bacterial Agents; Drug Resistance, Microbial; Humans; Male; Pneumonia; Recurrence; Rhodococcus equi; Rifampin

Physicians in the United States must maintain vigilance for the 25,000 annual new cases of tuberculosis, concentrated in the elderly, in immigrants, in migrant and minority populations, and in immunosuppressed patients. Tuberculosis rates in the South remain above the national average. Physicians diagnosing tuberculosis may also treat the disease, working with health departments, which can assist with drugs, follow-up tests, and contact investigation. Powerful short-course regimens have been standard treatments since 1986. The preferred combination is isoniazid, rifampin, and pyrazinamide daily for 2 months, followed by isoniazid and rifampin for 4 more months. A 9-month regimen of isoniazid and rifampin is equally effective. Supplementation or extension of these regimens is mandatory when drug resistance or immunosuppression, respectively, is likely. Isoniazid prophylaxis for 6 to 12 months continues to be a vital but often neglected preventive measure for those infected with Mycobacterium tuberculosis, but without active disease.

Topics: Acquired Immunodeficiency Syndrome; Adult; Aged; Child; Drug Administration Schedule; Drug Interactions; Drug Resistance, Microbial; Drug Therapy, Combination; Ethambutol; False Negative Reactions; Humans; Isoniazid; Pyrazinamide; Radiography, Thoracic; Rifampin; Risk Factors; Streptomycin; Tuberculosis; United States

The activities of sparfloxacin, azithromycin, temafloxacin, and rifapentine against two virulent strains of the Mycobacterium avium complex isolated from patients with AIDS were evaluated in a model of intracellular infection and were compared with that of clarithromycin. Human monocyte-derived macrophages were infected with the M. avium complex at day 6 of culture. The intracellular CFU was counted 60 min after inoculation. The intracellular and supernatant CFU was counted on days 4 and 7 after inoculation. The concentrations used, which were equal to peak levels in serum, were 10 micrograms of rifapentine per ml (MICs for the two strains, 4 and 16 micrograms/ml), 4 micrograms of clarithromycin per ml (MICs, 8 and 4 micrograms/ml), 1 microgram of azithromycin per ml (MICs, 32 and 16 micrograms/ml), 4 micrograms of temafloxacin per ml (MICs, 2 and 16 micrograms/ml), and 1 microgram of sparfloxacin per ml (MICs, 0.5 and 2 micrograms/ml). Compared with controls on day 7 after inoculation, clarithromycin (P less than 0.001), sparfloxacin (P less than 0.001), and azithromycin (P less than 0.001 for the first strain, P less than 0.02 for the second) slowed intracellular replication. Rifapentine (P less than 0.001) and temafloxacin (P less than 0.001) slowed intracellular replication of the first strain but not of the second strain. Azithromycin plus sparfloxacin was as effective as sparfloxacin alone. In this macrophage model, sparfloxacin or clarithromycin (difference not significant) exhibited a better efficacy than rifapentine, azithromycin, or temafloxacin against intracellular M. avium complex infection.

Topics: 4-Quinolones; Acquired Immunodeficiency Syndrome; Anti-Bacterial Agents; Azithromycin; Cell Division; Clarithromycin; Erythromycin; Fluoroquinolones; Humans; In Vitro Techniques; Leprostatic Agents; Macrophages; Microbial Sensitivity Tests; Mycobacterium avium Complex; Quinolones; Rifampin

From October 1987 to June 1988, we attempted to determine the prevalence of HIV infection among patients hospitalized with tuberculosis and the extent of immunosuppression among those tuberculosis patients infected with HIV. Of 178 consecutive patients, 18-65 years of age, who were hospitalized with newly diagnosed, previously untreated tuberculosis, 46% (82 out of 178) had clinical or serological evidence of HIV infection, 30% (54 out of 178) were HIV-seronegative, and 24% (42 out of 178) could not be assessed for the presence of HIV infection. Among the HIV-seropositive patients without an AIDS-defining diagnosis by non-tuberculous criteria, the median CD4 lymphocyte (CD4) count was 133 x 10(6) cells/l (range: 11-677 x 10(6]; among the HIV-seronegative patients, the median CD4 count was 613 x 10(6) cells/l (range: 238-1614 x 10(6); P less than 0.001). Among the HIV-seropositive patients, those with disseminated tuberculosis (median CD4 = 79 x 10(6) cells/l) and those with pulmonary tuberculosis who had radiographic evidence of mediastinal or hilar adenopathy (median CD4 = 45 x 10(6) cells/l) had the most severe CD4 depletion, whereas those with localized extrapulmonary tuberculosis (median CD4 = 242 x 10(6) cells/l) and those with pulmonary tuberculosis without adenopathy (median CD4 = 299 x 10(6) cells/l) were less severely immunosuppressed. Of the 178 patients, 6% (11 out of 178) were infected with strains of Mycobacterium tuberculosis resistant to both isoniazid and rifampin.

Topics: Acquired Immunodeficiency Syndrome; Adolescent; Adult; Aged; CD4-Positive T-Lymphocytes; Drug Resistance, Microbial; Female; HIV Seropositivity; HIV Seroprevalence; Humans; Immune Tolerance; Isoniazid; Leukocyte Count; Male; Middle Aged; Mycobacterium tuberculosis; New York City; Rifampin; T-Lymphocytes, Regulatory; Tuberculosis

From January 1984 to October 1990, 140 of 392 (35.7%) patients with the acquired immunodeficiency syndrome (AIDS) were found to have had tuberculosis. One hundred and sixteen were intravenous drug abusers and 16 were homosexual men. Fever, cough, weight loss and generalised lymphadenopathy were common features of their illness. Tuberculin skin tests were negative in 74% and 55% had intraabdominal lymphadenopathy. The chest radiographs showed hilar lymphadenopathy and lower lobe interstitial or alveolar infiltrates, but rarely cavitation. Forty-one of our patients had pulmonary tuberculosis, 38 had extra pulmonary and in 61 it was disseminated. In 80 cases tuberculosis was the presenting feature of AIDS. Tuberculosis usually responded well to chemotherapy.

Topics: Acquired Immunodeficiency Syndrome; Drug Therapy, Combination; Ethambutol; Female; Humans; Incidence; Isoniazid; Male; Prospective Studies; Pyrazinamide; Retrospective Studies; Rifampin; Risk Factors; Spain; Streptomycin; Substance Abuse, Intravenous; Tuberculosis; Tuberculosis, Pulmonary

During 1990 and 1991, outbreaks of multidrug-resistant tuberculosis (MDR-TB) in four hospitals (one in Miami and three in New York City) were investigated by CDC in collaboration with the reporting hospitals and state and local health departments. This report summarizes preliminary findings of the investigations and recommendations for prevention and control of MDR-TB outbreaks.

Topics: Acquired Immunodeficiency Syndrome; Cross Infection; Drug Resistance, Microbial; Ethambutol; Florida; HIV Infections; Humans; Isoniazid; New York City; Rifampin; Tuberculosis, Pulmonary

Topics: Acquired Immunodeficiency Syndrome; Cross Infection; Disease Outbreaks; Drug Resistance, Microbial; Ethambutol; Florida; HIV Infections; Humans; Isoniazid; Middle Aged; New York City; Rifampin; Tuberculosis, Pulmonary

Physicians at a district general hospital in London, England admitted a 26 year old pregnant political refugee from Uganda complaining of shortness of breath, fever, and a productive cough for 1 week. She was at 10 weeks gestation and had not yet sought prenatal care. 6 years earlier she had a child and her pregnancy and delivery were normal. They diagnosed an interstitial pneumonia based on an X ray, arterial gases, and quick breathing and administered intravenous (IV) ampicillin and erythromycin for 3 days. Her condition deteriorated nevertheless, so they had her blood tested for HIV. She tested positive and suspected pneumocystosis (later confirmed) and began treatment with IV Septrin and hydrocortisone. She worsened, and by the 10th day of this treatment she was receiving 60% oxygen. They changed her treatment to IV pentamidine and oral rifampicin and isoniazid. By this time, her white blood cell count was 28.7x109/1 and hemoglobin concentration 8.2g/dl. Her condition would not allow her to undergo general anesthesia so an abortion requested by the patient was not performed. Additional treatment included continuous infusion of eflornithine, but she died despite it. This case poses 2 questions. Could she have lived if there had not been a delay in HIV diagnosis? Research shows that CD4 lymphocytes cell counts fall considerably during pregnancy in HIV positive women. So some advocate prophylaxis earlier in these women than other immunocompromised patients. Was it indeed her pregnancy that contributed to the severity of her illness and its inability to respond to treatment? Some researchers find pregnancy accelerates the progress of HIV infection, but researchers do not yet know if it also accelerates the progress of opportunistic infections. If so, terminating pregnancy may be considered.

Topics: Acquired Immunodeficiency Syndrome; Adult; Eflornithine; Female; Humans; Isoniazid; Opportunistic Infections; Pneumonia, Pneumocystis; Pregnancy; Pregnancy Complications, Infectious; Prognosis; Rifampin

Topics: Acquired Immunodeficiency Syndrome; Adult; HIV Seropositivity; Humans; Male; Penicillins; Psoriasis; Recurrence; Rifampin

Infection with the human immunodeficiency virus (HIV) increases the risk of tuberculosis and may interfere with the effectiveness of antituberculosis chemotherapy. To examine the outcomes in patients with both diagnoses, we conducted a retrospective study of all 132 patients listed in both the acquired immunodeficiency syndrome (AIDS) and tuberculosis case registries in San Francisco from 1981 through 1988.. At the time of the diagnosis of tuberculosis, 78 patients (59 percent) did not yet have a diagnosis of AIDS, 18 patients (14 percent) were given a concomitant diagnosis of AIDS (as determined by the presence of an AIDS-defining disease other than tuberculosis), and the remaining 36 patients (27 percent) already had AIDS. The manifestations of tuberculosis were entirely pulmonary in 50 patients (38 percent), entirely extrapulmonary in 40 patients (30 percent), and both pulmonary and extrapulmonary in 42 patients (32 percent). The treatment regimens were as follows: isoniazid and rifampin supplemented by ethambutol for the first two months, 52 patients; isoniazid and rifampin supplemented by pyrazinamide and ethambutol for the first two months, 39 patients; isoniazid and rifampin, 13 patients; isoniazid and rifampin supplemented by pyrazinamide for the first two months, 4 patients; and other drug regimens, 17 patients. The intended duration of treatment for patients whose regimen included pyrazinamide was six months, and for patients who did not receive pyrazinamide, nine months. Seven patients received no treatment because tuberculosis was first diagnosed after death. Sputum samples became clear of acid-fast organisms after a median of 10 weeks of therapy. Abnormalities on all chest radiographs taken after three months of treatment were stable or improved except for those of patients who had new nontuberculous infections. The only treatment failure occurred in a man infected with multiple drug-resistant organisms who did not comply with therapy. Adverse drug reactions occurred in 23 patients (18 percent). For all 125 treated patients, median survival was 16 months from the diagnosis of tuberculosis. Tuberculosis was a major contributor to death in 5 of the 7 untreated patients and 8 of the 125 treated patients. Three of 58 patients who completed therapy had a relapse (5 percent); compliance was poor in all 3.. Tuberculosis causes substantial mortality in patients with advanced HIV infection. In patients who comply with the regimen, conventional therapy results in rapid sterilization of sputum, radiographic improvement, and low rates of relapse.

Topics: Acquired Immunodeficiency Syndrome; Adult; Drug Administration Schedule; Drug Therapy, Combination; Ethambutol; Female; Humans; Isoniazid; Male; Mycobacterium tuberculosis; Pyrazinamide; Retrospective Studies; Rifampin; Sputum; Tuberculosis; Tuberculosis, Pulmonary

Disease due to Mycobacterium avium complex (MAC) in patients with the acquired immunodeficiency syndrome (AIDS) typically occurs late in the course of AIDS and is usually disseminated with evidence of multiorgan involvement. Most patients are persistently bacteremic. Previously published studies have noted a poor response to antimycobacterial chemotherapy. We describe successful treatment of MAC disease in an AIDS patient with a multiple drug regimen, including amikacin, clofazimine, rifampin, ethambutol, and ciprofloxacin. This patient, whose presentation and MAC disease course distinctly differ from most published experience, remains clinically and microbiologically MAC-disease free 25 months after initiation of therapy. We describe four additional AIDS patients with MAC disease who had a favorable clinical and microbiological response to this regimen without developing serious adverse effects after periods ranging from 4 to 12 months. We suggest a prospective, controlled clinical trial using this regimen for treatment of MAC disease in patients with AIDS may be warranted.

Topics: Acquired Immunodeficiency Syndrome; Adult; Amikacin; Antitubercular Agents; Ciprofloxacin; Clofazimine; Drug Therapy, Combination; Ethambutol; Humans; Male; Middle Aged; Mycobacterium avium-intracellulare Infection; Rifampin

Morphine and its derivatives are metabolized by the liver microsomal enzyme system with a high first-pass effect after oral application. In four of 44 HIV-infected i.v. drug abusers who participated in a levomethadon maintenance program, we observed sustained symptoms of under-dosage and loss of effect of there to fore well-tolerated substitution therapy during rifampin treatment or therapy with zidovudine or fucidic acid. As a pharmacological model substance for cytochrome p 450 enzymes, measurement of antipyrine in serum by high pressure liquid chromatography revealed induction of cytochrome p 450 isoenzymes. The half-life of antipyrine decreased (patient 1 from 11.3 to 8.4 h and patient 2 from 10.7 to 7.6 h after rifampin, patient 3 from 12.2 to 8.6 h after fucidic acid, and patient 4 from 10.6 to 8.6 h after zidovudine). In i.v. drug abusers on levomethadon maintenance programs, adjustment of the levomethadon dosage may be necessary when specific therapy for HIV infection and associated diseases requires the use of drugs known to be potent inducers of the liver microsomal enzyme system.

Topics: Acquired Immunodeficiency Syndrome; Adult; Anti-Bacterial Agents; Dose-Response Relationship, Drug; Female; Fusidic Acid; Humans; Male; Methadone; Opioid-Related Disorders; Opportunistic Infections; Prospective Studies; Rifampin; Stereoisomerism; Substance Abuse, Intravenous; Zidovudine

We tested the activity of the new fluoroquinolone sparfloxacin (CI-978; AT 4140) against 30 strains of Mycobacterium avium complex (MAC) isolated from patients with acquired immune deficiency syndrome. MICs of sparfloxacin (range, less than or equal to 0.06 to 4 micrograms/ml) were lower than MICs of ciprofloxacin for all 30 strains, and MBCs for acid-fast bacteria were lower for 28 of the 30 strains. In synergism experiments using 10 strains of MAC, fractional inhibitory concentration indices revealed that the combination of sparfloxacin plus ethambutol was synergistic against 9 strains, and the three-drug combination of sparfloxacin plus ethambutol plus rifampin was synergistic against all strains. In the absence of ethambutol, the combination of sparfloxacin plus rifampin appeared to be antagonistic against three of the MAC strains.

Topics: Acquired Immunodeficiency Syndrome; Anti-Infective Agents; Ciprofloxacin; Drug Synergism; Ethambutol; Fluoroquinolones; Microbial Sensitivity Tests; Mycobacterium avium Complex; Mycobacterium avium-intracellulare Infection; Rifampin

The authors stress the recent increase of tuberculosis, especially in high-risk areas and populations. They illustrate the changes the disease has undergone lately, also with reference to a case they had occasion to observe. They describe 9-month and 6-month treatment schemes as well as the drugs that can be applied in cases of drug resistance which is rather frequent in AIDS patients.

Topics: Acquired Immunodeficiency Syndrome; Antitubercular Agents; Diagnosis, Differential; Ethambutol; Female; Humans; Isoniazid; Middle Aged; Rifampin; Tuberculosis; Tuberculosis, Lymph Node

Minimal inhibitory and bactericidal concentrations (MICs and MBCs) of rifampin (RMP), rifabutin (RBT), rifapentine (RPT), CGP-7040, and P-DEA, were determined for 50 M. avium strains in 7H12 liquid medium radiometrically under various pH conditions. Half were isolated from patients with AIDS and the other half from patients without AIDS but with pulmonary disease. The MICs and MBCs were also determined in 7H12 broth for M. tuberculosis strains. The MIC results obtained with M. tuberculosis strains, and the serum peak levels in humans, were used as standards for interpretation of the MICs and MBCs of the rifamycins for M. avium. The bactericidal activity of all rifamycins for M. avium was substantially lower than for M. tuberculosis. The majority of M. avium strains was within the "susceptible" category, e.g., comparable to susceptible M. tuberculosis strains, when tested with CGP-7040 and RPT, and all of them were "moderately susceptible" when tested with P-DEA. On the basis of in vitro bacteriostatic and bactericidal activity, it seems that three agents, RPT, P-DEA, and CGP-7040 have more potential than do RMP and RBT against M. avium disease.

Topics: Acquired Immunodeficiency Syndrome; Humans; Microbial Sensitivity Tests; Mycobacterium avium; Mycobacterium tuberculosis; Rifabutin; Rifampin; Rifamycins

Topics: Acquired Immunodeficiency Syndrome; Adult; Cryptococcosis; Drug Interactions; Fluconazole; Humans; Male; Meningitis; Rifampin

Topics: Acquired Immunodeficiency Syndrome; Adult; Humans; Male; Rifampin; Stevens-Johnson Syndrome; Tuberculosis, Pulmonary

Topics: Acquired Immunodeficiency Syndrome; Adult; Female; Humans; Male; Methadone; Mycobacterium avium-intracellulare Infection; Opioid-Related Disorders; Rifampin; Substance Abuse, Intravenous; Substance Withdrawal Syndrome

Topics: Acquired Immunodeficiency Syndrome; Administration, Oral; Developing Countries; Diagnosis, Differential; Disease Outbreaks; Drug Therapy, Combination; Humans; Isoniazid; Pyrazinamide; Rifampin; Tuberculosis

To determine the efficacy of combination drug therapy for disseminated Mycobacterium avium complex infection in patients with the acquired immunodeficiency syndrome (AIDS).. Prospective, nonrandomized, before-after comparison.. Outpatient clinics at three university medical centers.. Seventeen patients with at least two consecutive blood cultures positive for M. avium complex who had not been previously treated with antituberculous medications. Fifteen of the seventeen patients completed at least 4 weeks of treatment.. Patients received daily intravenous amikacin (7.5 mg/kg body weight) for the first 4 weeks plus the following oral medications for at least 12 weeks: ciprofloxacin, 750 mg twice daily; ethambutol, 1000 mg daily; and rifampin, 600 mg daily.. The baseline geometric mean colony count from blood cultures decreased from 537/mL to 14/mL (P less than 0.001) after 4 weeks of therapy. The microbiologic suppression was sustained while on treatment and was associated with a decrease in systemic symptoms related to M. avium complex infection. Premature withdrawal from treatment (less than 12 weeks) occurred in 7 of 17 patients. The commonest reasons for early withdrawal were gastrointestinal intolerance and hepatic toxicity.. Mycobacterial load and systemic symptoms in patients with AIDS and disseminated M. avium complex infection can be effectively reduced by a regimen containing amikacin, ethambutol, rifampin, and ciprofloxacin.

Topics: Acquired Immunodeficiency Syndrome; Administration, Oral; Amikacin; Chemical and Drug Induced Liver Injury; Ciprofloxacin; Drug Therapy, Combination; Ethambutol; Female; Humans; Infusions, Intravenous; Male; Mycobacterium avium-intracellulare Infection; Rifampin; Vomiting

The AIDS epidemic has made previously uncommon infectious diseases and tumors commonplace in HIV-infected individuals. In this article we discuss specific cases of various infections and tumors of the sinonasal tract. Several of these diseases may be the presenting signs of HIV-seropositivity and AIDS. As a result, the clinician first to see such patients must be aware of the diagnosis of these diseases and tumors so that proper testing and treatment may ensue.

Topics: Acquired Immunodeficiency Syndrome; Amphotericin B; Anti-Bacterial Agents; HIV Seropositivity; Humans; Ketoconazole; Nasopharyngeal Diseases; Opportunistic Infections; Paranasal Sinus Diseases; Rifampin; Therapeutic Irrigation

Three treatment protocols using rifabutine for mycobacterial infections resistant to rifampicin were prepared by a study group (GETIM) and were accepted by the ethical committee concerned. A prospective study has been carried out since April 1986. Thirty-five cases of tuberculosis with bacilli resistant to rifampicin received daily treatment with 5 to 7 mg/kg of rifabutine combined with several other drugs which were still active in vitro. Sixteen cases of M. xenopi infection occurred in individuals without apparent immune deficiency and they were treated with a daily combination of 5 to 7 mg/kg of rifabutine, 20 mg/kg of ethambutol, 3 to 5 mg/kg of isoniazid and 400 mg of ofloxacin (or 800 mg of pefloxacin). Twenty-one cases of M. avium-intracellulare infection, also in patients without any evident immune deficiency, and fifty-nine cases in patients suffering from the acquired immunodeficiency syndrome (AIDS), were treated with a similar combination in which the fluoroquinolone was replaced with 100 mg of clofazimine. During the first three months of treatment there were few major problems of toxicity or acceptability in the different combinations of drugs with the exception of three cases of leukopenia with thrombocytopenia. The proportion of negative cultures on the third month was 8 out of 24 (33%) for the cases of pulmonary tuberculosis and 10 out of 13 (77%) for the cases of M. xenopi infection, and 6 out of 11 (55%) and 9 out of 13 (69%), respectively, for infections by M. avium-intracellulare in subjects without immune deficiency and in subjects suffering from AIDS.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Acquired Immunodeficiency Syndrome; Adult; Aged; Drug Resistance, Microbial; Drug Therapy, Combination; Ethambutol; Female; Humans; Isoniazid; Male; Middle Aged; Mycobacterium avium-intracellulare Infection; Mycobacterium Infections; Mycobacterium Infections, Nontuberculous; Ofloxacin; Rifabutin; Rifampin; Rifamycins; Tuberculosis, Pulmonary

Topics: Acquired Immunodeficiency Syndrome; Adult; Anaphylaxis; Ciprofloxacin; Humans; Male; Rifampin; Tuberculosis

Topics: Acquired Immunodeficiency Syndrome; Adolescent; Age Factors; Anti-Bacterial Agents; BCG Vaccine; Child; Child, Preschool; Drug Therapy, Combination; Humans; Infant; Infant, Newborn; Isoniazid; Pyrazinamide; Rifampin; Tuberculosis

Two cases of Mycobacterium avium-intracellulare complex (MAC) infections are described, and the diagnosis, clinical features, and management of MAC infections are reviewed. In case 1, a four-year-old boy was diagnosed as having both acquired immunodeficiency syndrome (AIDS) and disseminated MAC infection. He was treated with a combination of isoniazid, ethambutol hydrochloride, rifabutin, and clofazimine. Results of susceptibility testing showed that the MAC was susceptible to rifabutin and ethambutol with intermediate susceptibility to isoniazid. The child developed severe adverse effects that necessitated the discontinuation of rifabutin therapy. Despite therapy, blood cultures remained positive for MAC. The child died of disseminated human immunodeficiency virus and MAC infection. In case 2, a 20-month-old girl was found to have a prevertebral retropharyngeal mass caused by MAC. The child did not have evidence of immunologic deficiency. She was treated with streptomycin, ethambutol, clofazimine, and rifabutin. Streptomycin was discontinued after three months. After seven months the mass decreased in size, allowing for surgical resection. Intraoperative cultures were negative for mycobacteria. Ethambutol, rifabutin, and clofazimine were continued for a total of 12 months, at which time the child was determined to be clinically and radiologically cured. Empiric multidrug antituberculous therapy should be initiated in patients with suspected disseminated nontuberculous mycobacterial infection because final isolation, identification, and susceptibility testing may take several weeks. Clofazimine and rifabutin, in combination with isoniazid and ethambutol, may be useful in the treatment of some MAC infections. At least four drugs are given, and regimens often consist of six drugs.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Acquired Immunodeficiency Syndrome; Anti-Bacterial Agents; Anti-Infective Agents; Child, Preschool; Ethambutol; Female; Humans; Infant; Isoniazid; Male; Microbial Sensitivity Tests; Mycobacterium avium; Mycobacterium Infections; Rifabutin; Rifampin; Rifamycins; Streptomycin

Rifampicin, an antituberculous drug, causes increased hepatic metabolism of steroid hormones. We report the case of a patient with the acquired immunodeficiency syndrome treated with rifampicin who had a 'normal' screening test for adrenal insufficiency, yet had clinical evidence of adrenal failure. Diagnostic testing could not be completed due to lack of clinical response to dexamethasone. Both of these findings are due to the unique effects of rifampicin on steroid metabolism.

Topics: Acquired Immunodeficiency Syndrome; Adrenal Cortex; Adrenal Cortex Function Tests; Adrenal Insufficiency; Adult; Humans; Liver; Male; Rifampin

Synergistic combinations of achievable serum levels of amikacin, rifampin, and ethambutol were tested for their ability to inhibit growth of Mycobacterium avium-intracellulare strains isolated from seven patients with acquired immune deficiency syndrome. Even when the isolates were very resistant to the individual antimicrobial agents in vitro, growth was completely inhibited by all combinations of the three agents tested. Four of the patients treated with a combined regimen of amikacin, rifampin, and ethambutol showed clinical improvement. Synergistic antimicrobial susceptibility tests seem to more accurately represent the efficacy of combined regimens used to treat these extremely resistant mycobacteria than do conventional susceptibility determinations with individual antimicrobial agents.

Topics: Acquired Immunodeficiency Syndrome; Amikacin; Drug Synergism; Drug Therapy, Combination; Ethambutol; Humans; Microbial Sensitivity Tests; Mycobacterium avium; Rifampin; Tuberculosis

A case of pulmonary infection with Mycobacterium tuberculosis in a patient with the acquired immune deficiency syndrome (AIDS) was studied. Diagnosis of AIDS was confirmed by the finding of pulmonary M tuberculosis with oral and oesophageal candidiasis accompanied by characteristic immunological changes with evidence of infection with human T cell lymphotropic virus III. Treatment of this patient was complicated by an unusual drug interaction between rifampicin and ketoconazole, leading to subtherapeutic serum concentrations and poor clinical response to treatment. Intravenous treatment was more effective than oral treatment. This drug interaction should be studied in greater detail as ketoconazole and rifampicin may be used together to treat patients with candidiasis and infection with M tuberculosis.

Topics: Acquired Immunodeficiency Syndrome; Adult; Drug Interactions; Humans; Injections, Intravenous; Ketoconazole; Male; Rifampin; Tuberculosis, Pulmonary