THE IMPACT OF HUMAN-IMMUNODEFICIENCY-VIRUS ON RESPONSE TO TREATMENT AND RECURRENCE RATE IN PATIENTS TREATED FOR TUBERCULOSIS - 2-YEAR FOLLOW-UP OF A COHORT IN LUSAKA, ZAMBIA

To examine the effect of HIV on response to treatment and recurrence r ate in patients with tuberculosis (TB), we have followed 239 previousl y untreated, adult, TB patients in a prospective cohort study in Lusak a, Zambia. One hundred and seventy-four (73%) were HTV-1 antibody posi tive. Patients with sputum smear positive, miliary, or meningeal TB we re prescribed 2 months daily streptomycin, thiacetazone, isoniazid, ri fampicin, pyrazinamide followed by 6 months thiacetazone and isoniazid ; others, 2 months streptomycin, thiacetazone and isoniazid followed b y 10 months thiacetazone and isoniazid. Thirty-five per cent of HN-pos itive (HIV+ve) and 9% of HIV-negative (HIV-ve) patients were known to have died before the scheduled end of treatment. Surviving HIV+ve pati ents showed weight gain and improvement in symptoms and laboratory and radiological findings similar to HIV - ve patients. The risk of cutan eous 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. Rec urrence of active TB was examined among 64 HIV+ve and 37 HIV-ve patien ts who successfully completed treatment, with mean follow-up after the end of treatment of 13.5 and 16.8 months, respectively. The rate of r ecurrence 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).