This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Frieden, T. R. Search for Related Content PubMed PubMed Citation Articles by Frieden, T. R.

Lack of Directly Observed Treatment Affects Tuberculosis Relapse Rates

The findings of Seyler and colleagues as reported in their recent article regarding risk factors for tuberculosis relapse among patients receiving antiretroviral treatment for HIV infection are potentially important (1). However, self-administration of antituberculosis drugs in the Ivory Coast likely affected reported tuberculosis relapse rates.

Patients who self-administer antituberculosis treatment are much more likely to relapse than patients who receive directly observed therapy (2, 3). In addition, self-administration of antituberculosis treatment increases the likelihood of inconsistent treatment; patients whose treatment is irregular or interrupted are 2.5 times more likely to relapse than adherent patients (4).

Directly observed antituberculosis treatment reduces the risk of relapse and death (5). Whether post-treatment prophylaxis would be indicated among patients who received optimal directly observed therapy for tuberculosis is not yet known.

Thomas R. Frieden

Commissioner, New York City Department of Health and Mental Hygiene, New York, New York

FOOTNOTES

Conflict of Interest Statement: T.R.F. does not have a financial relationship with a commercial entity that has an interest in the subject of this manuscript.

REFERENCES

1. Seyler C, Toure S, Messou E, Bonard D, Gabillard D, Anglaret X. Risk factors for active tuberculosis after antiretroviral treatment initiation in Abidjan. Am J Respir Crit Care Med 2005;172:123–127.[Abstract/Free Full Text]
2. Balasubramanian VN, Oommen K, Samuel R. DOT or not? Direct observation of anti-tuberculosis treatment and patient outcomes, Kerala State, India. Int J Tuberc Lung Dis 2000;4:409–413.[Medline]
3. Weis SE, Slocum PC, Blais FX, King B, Nunn M, Matney GB, Gomez E, Foresman BH. The effect of directly observed therapy on the rates of drug resistance and relapse in tuberculosis. N Engl J Med 1994;330: 1179–1184.[Abstract/Free Full Text]
4. Thomas A, Gopi PG, Santha T, Chandrasekaran V, Subramani R, Selvakumar N, Eusuff SI, Sadacharam K, Narayanan PR. Predictors of relapse among pulmonary tuberculosis patients treated in a DOTS programme in South India. Int J Tuberc Lung Dis 2005;9:556–561.[Medline]
5. Alwood K, Keruly J, Moore-Rice K, Stanton DL, Chaulk CP, Chaisson RE. Effectiveness of supervised, intermittent therapy for tuberculosis in HIV-infected patients. AIDS 1994;8:1103–1108.[Medline]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Frieden, T. R. Search for Related Content PubMed PubMed Citation Articles by Frieden, T. R.