Tuberculosis chemotherapy and sputum conversion among HIV-seropositive andHIV-seronegative patients in south-eastern Uganda

Objective: To investigate if there is a difference in response to tuberculo sis treatment between HIV seronegative and HIV seropositive patients follow ing two months of intensive phase tuberculosis treatment. Design: Prospective cohort study. Setting: St. Francis Leprosy Centre, south-east Uganda, Subjects: Four hundred fifty seven patients with never previously treated s putum smear-positive tuberculosis admitted during a two-year period in 1991 /1993, Intervention: Intensive phase treatment with streptomycin, isoniazid, rifam picin and pyrazinamide, Main outcome measures: Sputum conversion from a positive to a negative smea r at eight weeks of treatment. Results: HIV seropositivity prevalence was 28%, Among HIV seronegative pati ents, conversion to a negative smear status occurred in 76% persons compare d to 78% in HIV seropositive patients. This difference was not statisticall y significant (OR = 0.9; 95% CI, 0.6-1.5). HIV seropositive patients, howev er, were more likely to die (p = 0.017), A high prevalence of resistance to isoniazid and streptomycin was found, Isoniazid resistance was more likely in HIV seronegative patients with M, tuberculosis strains compared to HIV seropositive persons (p < 0.005). Initial resistance to antituberculosis dr ugs did not have a significant effect on smear conversion. Conclusion: This study demonstrates that HIV-seropositive status is not a p rincipal factor in delaying sputum conversion among patients receiving inte nsive phase tuberculosis treatment.