Increased recurrence of tuberculosis in HIV-1-infected patients in Kenya.
There is evidence that in human immunodeficiency virus 1 (HIV-1) infected patients with tuberculosis the rate of recurrence of tuberculosis is increased in those patients treated with a standard thiacetazone-containing regimen. To assess the impact of HIV-1 on tuberculosis in Kenya, patients with tuberculosis were studied prospectively. After treatment with either a standard thiacetazone plus isoniazid regimen or a short-course thiacetazone-containing regimen, overall recurrence rate of tuberculosis was 34 times greater in 58 HIV-1-positive patients than in 138 HIV-1-negative patients (adjusted rate ratio 33.8, 95% CI 4.3-264). Recurrence in the HIV-1-positive group was strongly associated with a cutaneous hypersensitivity reaction due to thiacetazone during initial treatment (rate ratio 13.2, 95% CI 3.1-56.2). In all patients with a cutaneous hypersensitivity reaction ethambutol was substituted for thiacetazone. No significant association was found between recurrence among HIV-1-positive patients and initial resistance, initial treatment regimen, a diagnosis of AIDS (WHO definition), or poor compliance. DNA fingerprinting suggested that both relapse and new infection may have produced recurrence of tuberculosis. In patients who had a cutaneous hypersensitivity reaction, increased recurrence rate may have been related to interruption of treatment, subsequent poor compliance, or more advanced immunosuppression. Alternatively, a change to the combination of ethambutol and isoniazid in the continuation phase for 11 months only may not be adequate.
Hawken
M
M
Department of Clinical Sciences, London School of Hygiene and Tropical Medicine, UK.
Nunn
P
P
Gathua
S
S
Brindle
R
R
Godfrey-Faussett
P
P
Githui
W
W
Odhiambo
J
J
Batchelor
B
B
Gilks
C
C
Morris
J
J
D017088:AIDS-Related Opportunistic Infections / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology*; D000163:Acquired Immunodeficiency Syndrome / Q000150:complications*; D000293:Adolescent; D000328:Adult; D000995:Antitubercular Agents / Q000627:therapeutic use; D015331:Cohort Studies; D003875:Drug Eruptions / Q000209:etiology; D004359:Drug Therapy, Combination; D004977:Ethambutol / Q000627:therapeutic use; D005260:Female; D006679:HIV Seropositivity; D015497:HIV-1; D006801:Humans; D007538:Isoniazid / Q000627:therapeutic use; D007630:Kenya / Q000453:epidemiology; D008297:Male; D012008:Recurrence; D012307:Risk Factors; D013828:Thioacetazone / Q000009:adverse effects / Q000627:therapeutic use; D014376:Tuberculosis / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology*
D000995:Antitubercular Agents; D004977:Ethambutol; D013828:Thioacetazone; D007538:Isoniazid