title: The impact of human immunodeficiency virus on response to treatment and recurrence rate in patients treated for tuberculosis: two-year follow-up of a cohort in Lusaka, Zambia.
abstract: To examine the effect of HIV on response to treatment and recurrence rate in patients with tuberculosis (TB), we have followed 239 previously untreated, adult, TB patients in a prospective cohort study in Lusaka, Zambia. One hundred and seventy-four (73%) were HIV-1 antibody positive. Patients with sputum smear positive, miliary, or meningeal TB were prescribed 2 months daily streptomycin, thiacetazone, isoniazid, rifampicin, pyrazinamide followed by 6 months thiacetazone and isoniazid; others, 2 months streptomycin, thiacetazone and isoniazid followed by 10 months thiacetazone and isoniazid. Thirty-five per cent of HIV-positive (HIV+ve) and 9% of HIV-negative (HIV-ve) patients were known to have died before the scheduled end of treatment. Surviving HIV+ve patients showed weight gain and improvement in symptoms and laboratory and radiological findings similar to HIV-ve patients. The risk of cutaneous drug reaction was 17% (95% CI: 12-25%) in HIV+ve, and 4% (1-13%) in HIV-ve patients. Severe rashes were attributed to thiacetazone. Recurrence of active TB was examined among 64 HIV+ve and 37 HIV-ve patients who successfully completed treatment, with mean follow-up after the end of treatment of 13.5 and 16.8 months, respectively. The rate of recurrence was 22/100 person years (pyr) for HIV+ve patients and 6/100 pyr for HIV-ve patients, giving a recurrence rate ratio of 4.0 (95% CI 1.2-13.8, P = 0.03).
authors.affiliation: School of Medicine, University of Zambia, Lusaka.
authors.forename: A M
authors.initials: AM
authors.lastname: Elliott
authors.forename: B
authors.initials: B
authors.lastname: Halwiindi
authors.forename: R J
authors.initials: RJ
authors.lastname: Hayes
authors.forename: N
authors.initials: N
authors.lastname: Luo
authors.forename: A G
authors.initials: AG
authors.lastname: Mwinga
authors.forename: G
authors.initials: G
authors.lastname: Tembo
authors.forename: L
authors.initials: L
authors.lastname: Machiels
authors.forename: G
authors.initials: G
authors.lastname: Steenbergen
authors.forename: J O
authors.initials: JO
authors.lastname: Pobee
authors.forename: P P
authors.initials: PP
authors.lastname: Nunn
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000188:drug therapy*; D000328:Adult; D000995:Antitubercular Agents / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D015497:HIV-1; D006801:Humans; D008297:Male; D011446:Prospective Studies; D012008:Recurrence; D016019:Survival Analysis; D016896:Treatment Outcome; D014376:Tuberculosis / Q000188:drug therapy*; D014504:Urban Health; D015024:Zambia
chemical_list: D000995:Antitubercular Agents