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  • Title: HIV seroprevalence rate and incidence of adverse skin reactions in adults with pulmonary tuberculosis receiving thiacetazone free anti-tuberculosis treatment in Yaounde, Cameroon.
    Author: Kuaban C, Bercion R, Koulla-Shiro S.
    Journal: East Afr Med J; 1997 Aug; 74(8):474-7. PubMed ID: 9487410.
    Abstract:
    To determine the HIV seroprevalence in adult patients with pulmonary tuberculosis in Yaounde and to compare the incidence of adverse skin reactions in patients with and without HIV infection receiving thiacetazone-free antituberculosis treatment, we studied 235 consecutive patients aged 15 years or more admitted into the Chest Clinic of Hospital Jamot in Yaounde with a diagnosis of pulmonary tuberculosis from July 1 to December 31, 1994. HIV testing was done using two ELISAs and confirmed by Western blot. Each patient was monitored for adverse skin reactions to antituberculosis treatment during the two month initial phase of therapy in hospital. Of the 235 patients studied, 156 (66%) were males (mean age: 33 years) and 79 were females (mean age: 30.3 years). Overall, 16.6% (39 cases) of the 235 patients were HIV seropositive. The prevalence of HIV infection was significantly higher in women (24%) than in men (12.5%) (p = 0.02). Adverse skin reactions to antituberculosis treatment were observed in eleven (4.7%) of the 235 patients. The incidence of the reactions was significantly higher in HIV seropositive (23.1%) than in HIV seronegative patients (1.0%) (p < 10 - 7). Two HIV seropositive patients who developed Stevens-Johnson syndrome died. The drugs incriminated for adverse skin reactions in the nine patients who survived were pyrazinamide (four cases) and rifampicin (five cases). A prospective study of 235 consecutive pulmonary tuberculosis (TB) patients admitted to Hospital Jamot in Yaounde, Cameroon, in a 6-month period in 1994 investigated the HIV seroprevalence in these patients and compared the incidence of adverse skin reactions in HIV-positive and HIV-negative patients receiving thiacetazone-free anti-TB treatment. Mean age was 33.0 years in the 158 male and 30.3 years in the 79 female patients. A total of 39 patients (16.6%) were HIV-seropositive; the seroprevalence rate was significantly higher in women (24.0%) than men (12.5%). Adverse skin reactions to anti-TB treatment were noted in 11 patients (4.7%) within 2-8 weeks of onset of treatment. Such reactions occurred in 9 (23.1%) of the HIV-positive patients compared with only 2 (1.0%) seronegative patients. The 2 patients (both HIV-positive) who developed Stevens-Johnson syndrome died. In the remaining 9 cases, reactions were mild to moderate and resolved with discontinuation of treatment (pyrazinamide or rifampicin) with or without the administration of symptomatic treatment. The World Health Organization has warned against use of thiacetazone in the treatment of TB in HIV-infected patients given the high frequency of sometimes fatal cutaneous hypersensitivity reactions. The findings of the present study indicate that, even when thiacetazone-free drugs are used, HIV-infected TB patients should be monitored carefully for adverse skin reactions.
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