The influence of HIV status on single and multiple drug reactions to antituberculous therapy in Africa.

OBJECTIVE

To document the influence of HIV status on drug reactions occurring in patients on antituberculous therapy in Harare, Zimbabwe.

DESIGN

Retrospective cohort study.

SETTING

City of Harare Tuberculosis Unit.

PATIENTS

Records of 906 patients with tuberculosis, of whom 162 reacted to antituberculous therapy, were analysed.

RESULTS

Reactions to antituberculous drugs were more frequent in HIV-positive (98 out of 363) than in HIV-negative (64 out of 543; P less than 0.0001) patients. The most common drug reaction was cutaneous hypersensitivity, occurring in 139 patients, 89 (64%) of whom were HIV-positive. Thiacetazone was implicated in 115 (82.7%) of the 139 cutaneous reactions and streptomycin in 10 (7.2%). Almost all cutaneous reactions occurred within 8 weeks of beginning treatment. Severe cutaneous reactions occurred more often in HIV-positive patients (P less than 0.001) and the only two deaths occurred in this group. Reactions to multiple drugs occurred in 18 HIV-positive and three HIV-negative patients (P = 0.017).

CONCLUSIONS

The use of thiacetazone and streptomycin in antituberculous drug regimens should be reassessed in those countries where coinfection with HIV and tuberculosis is common.