Purpose: The response to therapeutic schemes to tuberculosis associated with the infection by HIV virus represents a relevant situation. Currently recommended antituberculosis treatment in Brazil is with three drugs: rifampin, isoniazid, and pyrazinamide (RHZ). Alternative schemes such as streptomycin, isoniazid and ethambutol (SHM) have been tested, when adverse reactions are observed.
Methods: Retrospectively, 43 HIV-infected patients, that had used SHM as an alternative scheme for tuberculosis confirmed by direct examination, culture and anatomopathological, were analised. The data were obtained through a standard protocol.
Results: The sample group was of 34 men and 9 women with an average age of 33.5. 25.6% presented the pulmonary form, 46.5% presented extrapulmonary and 27.9% presented both. The most commonly found forms of extrapulmonary were the lymphatic in 19 patients and the miliary in 8. The initial therapeutic scheme used in 86% (37) was the RHZ, in 11.6 %(5) SHM and in 2,3% (1) RHM. In 39 patients (90.6%), there has been a change in the scheme, being hepatotoxicity the main reason, following by antiretroviral drugs use (protease inhibitors). The SHM has been the alternative scheme used in 38 from these patients. From the studied sample, 14% developed into cure and 21% in the death. In 1/3 of the cases the cause of the death was attributed to tuberculosis. 44% of the cases are still under treatment and in 21% the end was ignored.
Conclusion: The results show that the standard treatment for tuberculosis in AIDS patients has implicated in high change level because of hepatotoxicity and protease inhibitors use. The SHM scheme has been used as an effective and cheaper alternative.
Clinical Implications: Among the alternative schemes the SHM represents a satisfying alternative, and could be considered as a first line therapy for concomitant protease inhibitor use and previous hepatic diseases.
Luce1ia A Henn(*); A B John; L P Cadore and A Proengo. Servico de Pneumologia-HCPA, FAMED/UFRGS, Porto Alegre, Rio Grande do Sul, Brazil.
COPYRIGHT 1999 American College of Chest Physicians
COPYRIGHT 2000 Gale Group
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