Outcome of treating initial tuberculosis in the area south of Seville (Spain) over a five-year period (1994-1998)

Objective: To analyze the outcome of treating initial tuberculosis (ITB) in the hospital district south of Seville (Spain). Material and method: A descriptive study of treatment outcome in cases of I TB in our district between 1 January 1994 and 31 December 1998. Outcome was classified according to World Health Organization guidelines: successful ( S) potentially unsuccessful (PU), exitus (EX) and transferred out (T). Four hundred fifty-four patients (mean age 35 years) were enrolled; 22% were HI V+ and 21% were intravenous drug users (IVDU). Treatment was self-administe red in all cases, with 98% being given the standard prescription of 6 or 9 drugs. No subsequent case history was found for 15 cases, such that outcome could not be assessed. Results: Of the 439 evaluable cases, outcome was S for 74% (326/439), PU fo r 16% (70/439), EX for 8% (36/439) and T for 6. Outcome for HIV + patients was poorer than for HIV- patients (S: 35/98 versus 291/341, p<0.00005; PU: 40/98 versus 30/341, p<0.00005), and the mortality rate of HIV+ patients wa s higher than that of HIV- patients (EX: 18/98 versus 18/341, p<0.0008). Am ong those classified PU, no cases of treatment failure were recorded and up to 78% (31/40) were cases of loss of follow-up or abandonment. The variabl e most closely related to PU was IVDU status (OR 10.5, p<0.00005). Conclusion: a) Outcomes for the general population are acceptable. b) A mar ginal group has been identified as characterized by two variables, HIV+ and IVDU, which are the factors associated with poorer outcome of self-adminis tered treatment, indicating that supervised treatment is advisable in cases where those factors are present.