CLINICAL EXPERIENCE WITH RIFAMPIN-ISONIAZID-STREPTOMYCIN-ETHAMBUTOL (RISE)-RESISTANT TUBERCULOSIS

We review demographic and clinical features of 55 patients with rifampin-isoniazid-streptomycin-ethambutol (RISE)-resistant tuberculosis in our hospital from April 1, 1991, to July 31, 1993. Fifty-one of the 55 patients (median age, 36 years) were seropositive for human immunodeficiency virus (HIV), and 49 had AIDS. Among the HIV-infected patients, the median CD4 cell count was 31/mm. Forty-two patients died during the study period. Exogenous reinfection or superinfection with RISE-resistant tuberculosis occurred in 12 of 55 patients with a prior history of tuberculosis infection or disease. Fourteen of 55 received appropriate therapy, eight of whom became culture negative after a median of 68 days. Twelve of the 14 appropriately treated patients survived at least 6 months. When appropriately managed, even severely immunosuppressed individuals with HIV infection may have their RISE-resistant tuberculosis successfully controlled or eradicated. This infection however, remains highly lethal in the majority of patients with AIDS. Patients remain infectious for prolonged periods, even after appropriate therapy has been initiated.