Achieving international targets for tuberculosis treatment success among HIV-positive patients in New York City
DESIGN: Retrospective review of new TB patients diagnosed from 1995 to 2004, excluding patients with rifampin (RMP) resistance.
RESULTS: Of 9198 eligible TB patients, 83% had achieved treatment success, 8% died during treatment, 4% failed, 3% defaulted and 2% were transferred from NYC. Among 6374 HIV-negative individuals, treatment success was consistently over 85%; 5% died during treatment. Among 2824 HIV-positive individuals, treatment success was 72% overall and 66% in sputum acid-fast bacilli smear-positive patients. Mortality among the HIV-positive decreased from 26% in 1995 to 14% in 2004. HIV-positive patients achieved higher treatment success if 1) they received treatment by directly observed therapy (DOT) (82% vs. 74%, ORadj = 1.80, 95%CI 1.44–2.26), or 2) were administered rifabutin (RFB) in the regimen, a proxy for receiving antiretroviral therapy (ART) (84% vs. 78%, ORadj = 1.49, 95%CI 1.20–1.85). Treatment success of 85% was achieved in HIV-positive patients who received RFB and DOT.
CONCLUSION: High mortality precluded achieving 85% treatment success among HIV-positive TB patients. DOT and ART remain essential for improving success among co-infected patients everywhere.
Document Type: Regular Paper
Affiliations: 1: New York City Department of Health and Mental Hygiene, New York, New York, USA 2: New York City Department of Health and Mental Hygiene, New York, New York, USA; and Centers for Disease Control and Prevention, Atlanta, Georgia, USA
Publication date: 2010-12-01
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