***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: A controlled clinical trial of three short-course chemotherapy regimens was undertaken in patients with newly diagnosed bacteriologically positive pulmonary tuberculosis . The patients were r and omly allocated to receive one of three regimens : rifampicin , streptomycin , isoniazid and pyrazinamide daily for 2 months , followed by streptomycin , isoniazid and pyrazinamide twice weekly for 3 months ( R/5 ) or for 5 months ( R/7 ) , or the same regimen as R/7 but without rifampicin ( Z/7 ) . A bacteriological relapse requiring retreatment occurred by 5 years in 7.1 % of 126 R/5 , 4.0 % of 124 R/7 and 6.7 % of 253 Z/7 patients with organisms initially sensitive to streptomycin and isoniazid ; none of these differences is statistically significant . Of the 31 relapses , 16 occurred within 2 years of the completion of chemotherapy and the remaining 15 between 2 and 5 years . Among 65 patients with initial drug resistance to streptomycin or isoniazid or both , there were six bacteriological relapses requiring retreatment BACKGROUND Rifapentine is a cyclopentyl-substituted rifamycin whose serum half-life is five times that of rifampin . The US Public Health Service Study 22 compared a once-weekly regimen of isoniazid and rifapentine with twice weekly isoniazid and rifampin in the continuation phase ( the last 4 months ) of treatment for pulmonary tuberculosis in HIV-seropositive and HIV-seronegative patients . This report concerns only the HIV-seropositive part of the trial , which has ended . The HIV-seronegative part will stop follow-up in 2001 . METHODS Adults with culture-positive , drug-susceptible pulmonary tuberculosis who completed 2 months of four-drug ( isoniazid , rifampin , pyrazinamide , ethambutol ) treatment ( induction phase ) were r and omly assigned 900 mg isoniazid and 600 mg rifapentine once weekly , or 900 mg isoniazid and 600 mg rifampin twice weekly . All therapy was directly observed . Statistical analysis used univariate , Kaplan-Meier , and logistic and proportional hazards regression methods . FINDINGS 71 HIV-seropositive patients were enrolled : 61 completed therapy and were assessed for relapse . Five of 30 patients in the once-weekly isoniazid/rifapentine group relapsed , compared with three of 31 patients in the twice-weekly isoniazid/rifampin group ( log rank chi2=0.69 , p=0.41 ) . However , four of five relapses in the once-weekly isoniazid/rifapentine group had monoresistance to rifamycin , compared with none of three in the rifampin group ( p=0.05 ) . Patients who relapsed with rifamycin monoresistance were younger ( median age 29 vs 41 years ) , had lower baseline  CD4 cell counts ( median 16 vs 144 microL ) , and were more likely to have extrapulmonary involvement ( 75 % vs 18 % , p=0.03 ) and concomitant therapy with antifungal agents ( 75 % vs 9 % , p=0.006 ) . No  rifamycin monoresistant relapse has occurred among 1004 HIV-seronegative patients enrolled to date . INTERPRETATION Relapse with rifamycin monoresistant tuberculosis occurred among HIV-seropositive tuberculosis patients treated with a once-weekly isoniazid/rifapentine continuation-phase regimen . Until more effective regimens have been identified and assessed in clinical trials , HIV-seropositive people with tuberculosis should not be treated with a once-weekly isoniazid/rifapentine regimen The time is now right for r and omized trials of MDR-TB , say the authors , as the expansion of MDR-TB programs provides the setting in which trials can be implemented . In a study in Singapore 310 patients with sputum smear-positive pulmonary tuberculosis were allocated at r and om to daily chemotherapy with streptomycin , isoniazid , rifampin , and pyrazinamide ( 1 ) for 2 months ( 2SHRZ ) , ( 2 ) for 1 month ( 1SHRZ ) , or ( 3 ) for 2 months without streptomycin ( 2HRZ ) . This was followed for all patients by three times weekly isoniazid and rifampin to a total duration of 6 months . During the initial period of daily chemotherapy the patients were also allocated at r and om to be given their HRZ either as a combined formulation ( Rifater ) , each tablet containing 50 mg isoniazid , 120 mg rifampin , and 300 mg pyrazinamide , or as three separate drugs . During the Rifater versus separate drugs comparison the most common spontaneous complaints were of nausea and vomiting , reported by 8 % of 155 patients receiving Rifater and 7 % of 155 separate drugs . Other adverse effects were also reported in similar proportions in the two series . Among 271 patients with drug-susceptible strains of tubercle bacilli pretreatment there were no bacteriologic failures during chemotherapy . During 18 months of subsequent follow-up bacteriologic relapse occurred in 3 ( 7 % ) of 46 2SHRZ , 2 ( 5 % ) of 42 1SHRZ , and 3 ( 8 % ) of 40 2HRZ patients allocated to Rifater and in 0 of 47 2SHRZ , 1 ( 2 % ) of 46 1SHRZ , and 1 ( 2 % ) of 44 2HRZ patients allocated to separate drugs . There was no evidence of therapeutic benefit from continuing SHRZ administration beyond 1 month or from adding streptomycin to HRZ . The relapse rates were slightly higher in the Rifater series ( p = 0.04 ) . Further follow-up and results from other studies are therefore needed fully to assess the combined preparation The purpose of this study was to evaluate the impact of human immunodeficiency virus ( HIV ) infection on treatment for tuberculosis ( TB ) . The study population comprised 28,522 black Southern African gold miners . Patients with sputum culture-positive new or recurrent pulmonary TB diagnosed in 1995 were prospect ively enrolled in the cohort . Directly observed therapy ( DOT ) was practice d and outcomes were assessed at 6 mo after treatment was begun . There were 376 cases of TB ( incidence 1,318 per 100,000 ) , of which 190 ( 50 % ) were HIV positive and 82 ( 22 % ) had recurrent TB . There was no association between HIV status and history of previous TB or drug resistance . Neither the treatment interruption rate ( 2 % ) nor the rate at which patients transferred out of the treatment program ( 1.6 % ) were associated with HIV status . Excluding deaths , cure rates were similar for HIV-positive and HIV-negative patients ( 89 % versus 88 % ) , but significantly lower in those with recurrent than in those with new TB ( 77 % versus 92 % ) . Mortality was 0.5 % in HIV-negative patients versus 13.7 % in HIV-positive patients , and in the latter group was associated with CD4(+ ) lymphocyte depletion . Autopsy examination showed that in HIV-positive patients , early mortality was due to TB whereas late deaths were most commonly due to cryptococcal pneumonia . The study showed that a well-run TB control program can result in acceptable cure rates even in a population with a very high incidence of TB and HIV infection . Particular vigilance is needed for concurrent infections , which may contribute significantly to mortality during treatment of TB in HIV-positive patients The bacteriological relapse rates up to 30 months after the start of chemotherapy have been compared for 4 daily short-course regimens for pulmonary tuberculosis . All 4 had the same initial 2-month intensive phase of streptomycin , isoniazid , rifampicin and pyrazinamide ( SHRZ ) followed by isoniazid plus rifampicin for 4 months ( 4HR ) , or isoniazid plus pyrazinamide for 4 months ( 4HZ ) , or isoniazid alone for 4 months ( 4H ) , or isoniazid alone for 6 months ( 6H ) . In patients with fully sensitive strains pretreatment , the 6-month regimen with rifampicin throughout ( 4HR ) was highly effective , only 2 % of 166 patients relapsing bacteriologically in 24 months of follow-up after stopping chemotherapy . This regimen was significantly better than the 4H regimen which had a relapse rate of 10 % in 156 patients ( P less than 0.02 ) and the 4HZ regimen which had a relapse rate of 8 % in 164 patients ( P = 0.05 ) . The 6H regimen was also highly effective , only 3 % of the 123 patients relapsing , compared with 10 % of the 156 on the 4H regimen ( P = 0.06 ) . The relapse rate of the regimen with pyrazinamide throughout ( 4HZ ) , was not significantly different from that of either of the regimens with isoniazid alone in the continuation phase . All except 3 ( 1 4HR , 1 4HZ , 1 4H ) of the 36 relapses were with fully drug-sensitive strains . In patients with strains resistant to isoniazid alone pretreatment none of the 23 on the 4HR or 4HZ regimens had an unfavourable bacteriological status at the end of chemotherapy compared with 8 of the 17 patients ( P less than 0.005 ) on 4H or 6H regimens . Of the patients assessed , 3 of 20 receiving rifampicin or pyrazinamide throughout relapsed compared with 2 of 8 who did not A controlled study of three short-course regimens was undertaken in South Indian patients with newly diagnosed , sputum-positive pulmonary tuberculosis . The patients were allocated at r and om to one of three regimens : a ) Rifampicin , streptomycin , isoniazid and pyrazinamide daily for 3 months ( R3 ) ; b ) the same regimen as above but followed by streptomycin , isoniazid and pyrazinamide twice-weekly for a further period of 2 months ( R5 ) ; c ) the same as R5 but without rifampicin ( Z5 ) . A bacteriological relapse requiring treatment occurred by 5 years in 16.8 % of 113 R3 , 5.2 % of 97 R5 , and 20.0 % of 115 Z5 patients with organisms sensitive to streptomycin and isoniazid initially . The differences in the relapse rates between the R3 and R5 regimens and the R5 and Z5 regimens were statistically significant ( p less than 0.01 for both ) . Considering patients with organisms initially resistant to streptomycin or isoniazid or both , 7 of 52 patients ( 4 R3 , 2 R5 , 1 Z5 ) had a bacteriological relapse requiring retreatment In a previous study , we have shown that a 6-month regimen consisting of 2 months of isoniazid , rifampin , pyrazinamide , and streptomycin administered daily ( 2IRSZ ) followed by 4 months of isoniazid and rifampin administered twice weekly ( 4I2R2 ) yielded no relapses after 30 months of follow-up . In order to assess the contribution of streptomycin to this treatment regimen , 213 patients with newly detected smear-positive pulmonary tuberculosis were r and omly assigned to the following two 6-month treatment regimens : 2IRZ/4I2R2 and 2IRSZ/4I2R2 .  One hundred seventy-two of the 213 patients ( 81 % ) completed therapy , i.e. , 116 of 135 patients ( 86 % ) treated with 2IRZ/4I2R2 and 56 of 78 patients ( 72 % ) treated with 2IRSZ/4I2R2 . Adverse reactions requiring withdrawal of drugs for 7 days or longer were observed in 4.2 % of patients ( 3.7 % receiving the 2IRZ/4I2R2 regimen and 5.1 % receiving the 2IRSZ/4I2R2 regimen ) . At the end of treatment , all patients in the 2IRZ/I2R2 series had negative smears and cultures . Two of the 116 patients ( 1.7 % ) in the 2IRZ/I2R2 series developed isoniazid resistance in the fourth month of treatment and remained sputum positive at the end of treatment . In the follow-up period , 4 patients ( 3.4 % ) treated with 2IRZ/4I2R2 relapsed and 1 ( 1.8 % ) treated with 2IRSZ/4I2R2 relapsed . The only significant difference between the 2 regimens was the higher dropout rate among those assigned to the 2IRSZ/4I2R2 regimen OBJECTIVE --To examine the relation between damp and mould growth and symptomatic ill health . DESIGN --Cross-sectional study 
    Output:
    
Findings showed that poor outcomes were associated with initial drug resistance and that treatment was not based on susceptibility testing .