CUTANEOUS HYPERSENSITIVITY REACTIONS DUE TO THIACETAZONE IN THE TREATMENT OF TUBERCULOSIS IN ZAMBIAN CHILDREN INFECTED WITH HIV-I

Tuberculosis is one of the most common infections in Zambian adults an d children infected with HIV. In Africa, cutaneous hypersensitivity re actions attributed to thiacetazone during treatment of tuberculosis in adults infected with HIV-I have been well documented. This study moni tored adverse drug reactions during treatment for tuberculosis over an 18 month period (1 April 1990 to 31 October 1991) in 237 children wit h a clinical diagnosis of tuberculosis (125 boys and 112 girls; 88/237 (37%) infected with HIV-I) and 242 control children (149 boys and 93 girls; 26/242 (11%) infected with HIV-I). Twenty two (9%) of the 237 c hildren with tuberculosis developed hypersensitivity skin reactions du ring the course of treatment. Adverse skin reactions were seen more of ten in children infected with HIV than in those who were not (odds rat io 11.65, 95% confidence interval 3.07 to 34.88). These represented 19 (21%) of 88 children infected with HIV and three (2%) of 149 children not infected with HIV. These skin reactions occurred after a period o f treatment ranging between two and four weeks among 14 children recei ving the HST (isoniazid, streptomycin, thiacetazone) regimen and eight children receiving the HSTR (isoniazid, streptomycin, thiacetazone, r ifampicin) regimen. Twelve (55%) of the 22 children who reacted advers ely to treatment developed the Stevens-Johnson syndrome. All 12 of the se children with the Stevens-Johnson syndrome were infected with HIV. The mortality among these children who developed the Stevens-Johnson s yndrome was 91% (11 of 12 died within three days of the onset of the r eaction). No further reactions were observed in the 11 children who re covered from the cutaneous hypersensitivity reactions after thiacetazo ne was discontinued over a period of six months of further treatment f or tuberculosis. The results of this study were in part responsible fo r the recommendations put forward by the World Health Organisation to avoid the use of thiacetazone in the treatment of tuberculosis in chil dren infected with HIV.