Is oral intermittent initial phase anti-tuberculosis treatment associated with higher mortality in high HIV-prevalent areas in sub-Saharan Africa?

The Malawi Tuberculosis Programme has evaluated an oral ambulatory treatmen t regimen (2R(3)H(3)Z(3)E(3)/6HE) in five districts, and observed a mortali ty rate of 23% in 2671 new patients with smear-positive pulmonary tuberculo sis (PTB). Three studies were performed comparing treatment outcomes betwee n patients treated with 2R(3)H(3)Z(3)E(3)/6HE and 2SRHZ/6HE using historica l data in the same districts and concurrent data in different districts. Us ing historical comparisons, mortality was significantly higher with 2R(3)H( 3)Z(3)E(3)/6HE than 2SRHZ/6HE. Using concurrent comparisons, mortality was similar, although there was a higher death rate in the first month with the intermittent regimen. The intermittent regimen may be inferior to the esta blished regimen.