HUMAN-IMMUNODEFICIENCY-VIRUS TYPE-1 INFECTION IN ZAMBIAN CHILDREN WITH TUBERCULOSIS - CHANGING SEROPREVALENCE AND EVALUATION OF A THIOACETAZONE-FREE REGIMEN

Setting: This study was conducted at the Department of Paediatrics and Child Health, University Teaching Hospital (UTH), in Lusaka, Zambia. Objectives: To monitor the seroprevalence of HIV type-1 in children wi th tuberculosis and to evaluate the response to anti-tuberculosis ther apy using a thioacetazone-free treatment regimen. Design: A prospectiv e cross-sectional study of all consecutive newly diagnosed cases of TB in children from 1 month-15 ears of age seen at the University Teachi ng Hospital (UTH) in Lusaka, Zambia between 1 October 1991 and 31 May 1992. Results: 120 children with a clinical diagnosis of tuberculosis and 167 controls were enrolled in the study. The overall HIV type-1 se roprevalence rate in children with tuberculosis was 55.8% (67/120) com pared to 9.6% (16/167) amongst the control group (P < 0.0001: odds rat io = 11.50; 95% CI = 5.99-22.7). Common clinical presentations among c hildren with TB were bronchopneumonia (45/162), miliary TB (30/162) an d tuberculous lymphadenopathy (21/33). There were no significant diffe rences in clinical presentation of TB between the HIV-negative and HIV -positive groups. The follow-up of those patients with tuberculosis wa s poor, with only 65 patients (55%) returning to the clinic for schedu led appointments after discharge. All the 16 patients who died did so within 60 days of discharge from hospital; all of them were seropositi ve for HIV. There were no deaths among the HIV-negative group. Despite the exclusion of thioacetazone from the treatment regimen, cutaneous reactions occurring within 8 weeks of commencing treatment were observ ed in 7 of the 65 (11%) patients, 2 of whom developed fatal Stevens-Jo hnson syndrome. All 7 patients were seropositive for HIV-1. Conclusion s: The seroprevalence rate of HIV type-1 among children with tuberculo sis in Lusaka continues to rise; careful monitoring of anti-TB therapy (even in regimens excluding thioacetazone) for potentially lethal sid e effects should be carried out.