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Increased recurrence of tuberculosis in HIV-1-infected patients in Kenya

Increased recurrence of tuberculosis in HIV-1-infected patients in Kenya
Increased recurrence of tuberculosis in HIV-1-infected patients in Kenya
There is evidence that in human immunodeficiency virus 1 (HIV-1) infected patients with tuberculosis the rate of recurrence of tuberculosis is increased in those patients treated with a standard thiacetazone-containing regimen. To assess the impact of HIV-1 on tuberculosis in Kenya, patients with tuberculosis were studied prospectively. After treatment with either a standard thiacetazone plus isoniazid regimen or a short-course thiacetazone-containing regimen, overall recurrence rate of tuberculosis was 34 times greater in 58 HIV-1-positive patients than in 138 HIV-1-negative patients (adjusted rate ratio 33·8, 95% Cl 4·3-264). Recurrence in the HIV-1-positive group was strongly associated with a cutaneous hypersensitivity reaction due to thiacetazone during initial treatment (rate ratio 13·2, 95% Cl 3·1-56·2). In all patients with a cutaneous hypersensitivity reaction ethambutol was substituted for thiacetazone. No significant association was found between recurrence among HIV-1-positive patients and initial resistance, initial treatment regimen, a diagnosis of AIDS (WHO definition), or poor compliance. DNA fingerprinting suggested that both relapse and new infection may have produced recurrence of tuberculosis. In patients who had a cutaneous hypersensitivity reaction, increased recurrence rate may have been related to interruption of treatment, subsequent poor compliance, or more advanced immunosuppression. Alternatively, a change to the combination of ethambutol and isoniazid in the continuation phase for 11 months only may not be adequate
0140-6736
332-337
Hawken, M.
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Nunn, P.
2d7ddc4a-f5aa-4ef0-9c5e-5b7be3d4b8ef
Gathua, S.
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Brindle, R.
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Godfrey-Faussett, P.
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Githui, W.
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Odhiambo, J.
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Batchelor, B.
6719a636-2a2c-47a6-9e4e-c72d0065ceb7
Gilks, C.
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Morris, J.S.
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McAdam, K.
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Hawken, M.
c56bca1e-46f2-4909-a041-b7210611baaf
Nunn, P.
2d7ddc4a-f5aa-4ef0-9c5e-5b7be3d4b8ef
Gathua, S.
6a397cb4-6546-4c4a-b66a-c80a08929e54
Brindle, R.
cfabdbbd-39c7-4b3f-8417-3090689b58eb
Godfrey-Faussett, P.
5c1047a6-ac3f-45ed-81c8-4549cd652caa
Githui, W.
9d78f21a-c8af-4952-98f0-14b630ef675b
Odhiambo, J.
2bc83921-ecf8-49e6-a637-764faa925c05
Batchelor, B.
6719a636-2a2c-47a6-9e4e-c72d0065ceb7
Gilks, C.
45c235a6-fc8d-4aa8-aeb7-564c338e5796
Morris, J.S.
569aa43b-15bd-4e9d-b4a5-e68a84334cfe
McAdam, K.
2947c16d-a6c1-4c76-9f57-8dfd801eb3ce

Hawken, M., Nunn, P., Gathua, S., Brindle, R., Godfrey-Faussett, P., Githui, W., Odhiambo, J., Batchelor, B., Gilks, C., Morris, J.S. and McAdam, K. (1993) Increased recurrence of tuberculosis in HIV-1-infected patients in Kenya. The Lancet, 342 (8867), 332-337. (doi:10.1016/0140-6736(93)91474-Z).

Record type: Article

Abstract

There is evidence that in human immunodeficiency virus 1 (HIV-1) infected patients with tuberculosis the rate of recurrence of tuberculosis is increased in those patients treated with a standard thiacetazone-containing regimen. To assess the impact of HIV-1 on tuberculosis in Kenya, patients with tuberculosis were studied prospectively. After treatment with either a standard thiacetazone plus isoniazid regimen or a short-course thiacetazone-containing regimen, overall recurrence rate of tuberculosis was 34 times greater in 58 HIV-1-positive patients than in 138 HIV-1-negative patients (adjusted rate ratio 33·8, 95% Cl 4·3-264). Recurrence in the HIV-1-positive group was strongly associated with a cutaneous hypersensitivity reaction due to thiacetazone during initial treatment (rate ratio 13·2, 95% Cl 3·1-56·2). In all patients with a cutaneous hypersensitivity reaction ethambutol was substituted for thiacetazone. No significant association was found between recurrence among HIV-1-positive patients and initial resistance, initial treatment regimen, a diagnosis of AIDS (WHO definition), or poor compliance. DNA fingerprinting suggested that both relapse and new infection may have produced recurrence of tuberculosis. In patients who had a cutaneous hypersensitivity reaction, increased recurrence rate may have been related to interruption of treatment, subsequent poor compliance, or more advanced immunosuppression. Alternatively, a change to the combination of ethambutol and isoniazid in the continuation phase for 11 months only may not be adequate

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Published date: August 1993
Organisations: Faculty of Health Sciences

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Local EPrints ID: 365121
URI: https://eprints.soton.ac.uk/id/eprint/365121
ISSN: 0140-6736
PURE UUID: 1e2fb8a4-1377-41ef-9629-e27cc7943fd4

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Date deposited: 23 May 2014 12:25
Last modified: 05 Oct 2018 12:09

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Contributors

Author: M. Hawken
Author: P. Nunn
Author: S. Gathua
Author: R. Brindle
Author: P. Godfrey-Faussett
Author: W. Githui
Author: J. Odhiambo
Author: B. Batchelor
Author: C. Gilks
Author: J.S. Morris
Author: K. McAdam

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