March 6, 1998


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 of TB."

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 campus.