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 < 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 < 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.