Low treatment adherence by outpatients strongly contributes to the high tuberculosis mortality rate in HIV patients, according to researchers in Portugal. "Adherence to antituberculosis treatment, a major determinant of outcome, is of special concern in [HIV]-positive patients," explained M. Rocha and colleagues at the University of Porto's Center for Respiratory Disease Diagnosis in Constituicao. "However, tuberculosis death in HIV-positive patients remains higher than in HIV-negative patients, regardless of adherence."

Looking to assess determinants for an unfavorable tuberculosis outcome, defined as no cure or death, as well as nonadherence to antituberculosis treatment, the researchers examined 70 HIV-positive patients with TB who were referred to an outpatient center.

"Patient outcome was compared to HIV risk factors, other opportunistic diseases, antiretroviral drug use, current IV drug use, a methadone program participation, tuberculosis features, treatment characteristics and adherence," they noted. The researchers also compared adherent and nonadherent patient characteristics.

"An unfavorable outcome occurred in 22.9 percent of patients and 32.9 percent were nonadherent with therapy," the data showed. "Nonadherence was the only independent determinant for an unfavorable outcome," said the researchers.

According to the report, "adherence was independently associated with current IV drug use, treatment complications and use of methadone."

Thus, the study "confirms that [HIV]-infected patients, treated as outpatients, have high rates of nonadherence and that adherence is the strongest determinant for tuberculosis outcome," concluded the study authors. "Independently of the current use of drugs, a methadone program improves adherence to treatment," they noted.

The study, "The Role of Adherence in Tuberculosis HIV-Positive Patients Treated in Ambulatory Regimen," was published in European Respiratory Journal (2003;21(5):785-788).

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