CUTANEOUS REACTIONS TO THIACETAZONE IN ZAMBIA - IMPLICATIONS FOR TUBERCULOSIS TREATMENT STRATEGIES

Tuberculosis in patients infected with human immunodeficiency virus (H IV) is a growing threat to public health in Africa, Thiacetazone, one of the continent's most widely used antituberculous agents, may lead t o severe cutaneous reactions in the HIV infected individual. We descri be the impact of this reaction on the tuberculosis (TB) control progra mme of a district hospital in Zambia in 1990, and examine the cost imp lications of changing the standard treatment regime. We carried out a retrospective survey of records of all patients beginning TB treatment in 1990, together with HIV test results and the cost of all treatment s given. From this we derived estimates of costs of different regimes which are and could be used in TB control in Zambia. Severe reactions occurred in 18.7% of all HIV seropositive patients receiving thiacetaz one, fatally so in 1.2% (odds ratio 16.6). The greatest part of the co st of the current regime is that attributable to the inpatient stay; w e estimated that 29.4% of patients would be unable to receive drugs as out-patients but, even allowing for this, rifampicin-based regimes gi ven to outpatients where possible would not cost more than the current strategy. We conclude that ethical and economic considerations suppor t a change to rifampicin-based regimes in areas of Africa where HIV se roprevalence is high.