March 6, 1998
HEALTH SCIENCE CENTER PHYSICIANS PUBLISH RESULTS OF LINK BETWEEN TB AND HIV
FORT WORTH, Texas -- Physicians at the UNT Health Science Center studied the
relationship between drug-resistant tuberculosis and HIV infection, and concluded
that HIV infection is not a risk factor for drug-resistant tuberculosis. Results
of the physiciansÕ research were reported in the current edition of the AIDS
Journal (Volume 12, No. 2).
Drs. Stephen E. Weis and Craig Spellman, both internal medicine clinicians at the
health science center and part of the center's Physicians & Surgeons Medical
Group, followed all TB patients at the Tarrant County Public Health Department
over 10 years. The doctors compared the prevalence of drug-resistant TB among
patients with and without HIV infection.
All patients were treated using "directly observed therapy," a therapy unique to
the Tarrant County study. The study demonstrated that the use of directly
observed therapy where patients are closely supervised for care was effective in
treating all cases of TB. Since evidence showed that drug-resistant disease is
not related to or caused by HIV-infection, it seems it can be prevented with
direct observed therapy (DOT). DOT was developed by Dr. Weis in 1986, and his
protocols are now used around the world.
The debate of whether HIV infection is a risk factor for drug-resistant
tuberculosis has been argued for years. The question surfaced after the Centers
for Disease Control and Prevention reported outbreaks of drug-resistant disease
among HIV-infected people in New York City and Miami. Some researchers have
associated drug-resistant TB with HIV infection, Dr. Spellman said.
Tuberculosis, or TB, is an infectious disease caused by bacteria called
Mycobacterium, and is characterized by the forming of lesions in the lungs. TB
spreads from person to person through the air. If TB is left untreated, it can
cause death. For those with drug-resistant TB, no effective medication is
available to treat the disease.
"HIV infection was believed for many years to be one of the culprits in the
development of drug-resistant TB," said Dr. Spellman. "If HIV infection is not a
risk factor as once thought, we need to re-examine how public health dollars are
being spent to determine how the disease is contracted and how to avoid new cases
Factors closely associated with TB included race/ethnicity, foreign birth, and a
prior diagnosis of TB. Sex, age, chronic alcohol use and place of residence were
not associated with drug resistance, as was the case with a positive HIV status.
HIV disease was more common among drug users, men, middle-aged adults, certain
races, persons born in the U.S. and persons living in community-based facilities.
History of chronic alcohol use, prior diagnosis of TB and drug resistance did not
differ significantly between the two groups.
Tarrant County's largest medical group, the Physicians & Surgeons Medical Group,
is composed of faculty of the UNT Health Science Center's Texas College of
Osteopathic Medicine. The group includes 112 physicians and surgeons who practice
and teach in 24 specialties and sub specialties, including allergy/immunology,
cardiology, oncology/hematology, neurology, surgery and sports medicine. The
health science center's new 135,000 square-foot Patient Care Building is located
on the Montgomery Street side of the health science center's Cultural District