Human immunodeficiency virus type-1 infection in Zambian children with tuberculosis: changing seroprevalence and evaluation of a thioacetazone-free regimen.

Abstract

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 with tuberculosis and to evaluate the response to anti-tuberculosis therapy using a thioacetazone-free treatment regimen.

DESIGN:

A prospective cross-sectional study of all consecutive newly diagnosed cases of TB in children from 1 month-15 years of age seen at the University Teaching 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 seroprevalence rate in children with tuberculosis was 55.8% (67/120) compared to 9.6% (16/167) amongst the control group (P < 0.0001: odds ratio = 11.50; 95% CI = 5.99-22.7). Common clinical presentations among children with TB were bronchopneumonia (45/162), miliary TB (30/162) and tuberculous lymphadenopathy (21/33). There were no significant differences in clinical presentation of TB between the HIV-negative and HIV-positive groups. The follow-up of those patients with tuberculosis was poor, with only 65 patients (55%) returning to the clinic for scheduled appointments after discharge. All the 16 patients who died did so within 60 days of discharge from hospital; all of them were seropositive 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 observed in 7 of the 65 (11%) patients, 2 of whom developed fatal Stevens-Johnson syndrome. All 7 patients were seropositive for HIV-1.

CONCLUSIONS:

The seroprevalence rate of HIV type-1 among children with tuberculosis in Lusaka continues to rise; careful monitoring of anti-TB therapy (even in regimens excluding thioacetazone) for potentially lethal side effects should be carried out.

• Authors: C Luo, C Chintu, G Bhat, M Raviglione, V Diwan, H L DuPont, A Zumla
• Journal: Tubercle and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease (Tuber Lung Dis) Vol. 75 Issue 2 Pg. 110-5 (Apr 1994) ISSN: 0962-8479 [Print] Scotland
• PMID: 8032043 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't, Research Support, U.S. Gov't, P.H.S.)

Chemical References

• Pyrazinamide
• Isoniazid
• Rifampin
• Streptomycin

Topics

• Adolescent
• Child
• Child, Preschool
• Drug Hypersensitivity
• Drug Therapy, Combination (therapeutic use)
• Female
• HIV Infections (complications)
• HIV Seroprevalence (trends)
• HIV-1
• Humans
• Infant
• Isoniazid (therapeutic use)
• Male
• Prospective Studies
• Pyrazinamide (therapeutic use)
• Rifampin (therapeutic use)
• Streptomycin (therapeutic use)
• Treatment Outcome
• Tuberculosis, Pulmonary (complications, drug therapy, epidemiology)
• Zambia (epidemiology)