Clinical aspects and treatment outcome in HIV-associated pulmonary tuberculosis: an experience from a Thai referral centre.

This case-control study examined the impact of HIV infection on clinical presentation, response to treatment, and outcome of pulmonary tuberculosis. Symptoms, radiographic pattern, sputum direct smear, drug susceptibility, treatment outcome and adverse reactions of 88 HIV-infected patients with newly-diagnosed, culture-proved, untreated pulmonary tuberculosis were compared with those of age and gender-matched HIV-seronegative patients. No differences in the frequency of pyrexia, dyspnoea, cough or haemoptysis were evident. Cavitary lesions and upper zone infiltrates were observed significantly less often in the HIV-infected group (p = 0.02 and 0.01, respectively). Direct smear positivity was comparable in the 2 groups. The resistance rates to antituberculous drugs were not different except for Streptomycin which was higher among the HIV-infected patients (p = 0.01). Cutaneous hypersensitivity reactions and drug-induced hepatitis occurred more often in the HIV-seropositive group, albeit not reaching statistical significance. Default was much higher in the HIV-infected patients (33%); however, the culture conversion rate was satisfactory among those completed treatment. Twelve HIV-infected patients died during the course of treatment, four of whom as a result of tuberculosis. Based on these observations, physicians should maintain a high index of suspicion for tuberculosis among HIV-seropositive patients for short-course chemotherapy to be promptly instituted.

Prevalence of drug resistance in Thai human immunodeficiency virus seropositive tuberculosis patients.

The emergence of drug resistant tuberculosis has been reported from many countries which have had epidemics of human immunodeficiency virus (HIV) infection. This study was conducted at the Central Chest Hospital, Thailand in order to determine the prevalence of drug resistance before treatment in Thai HIV-infected tuberculosis patients. From the Statistics and Registration Unit, pulmonary tuberculosis patients with HIV seropositivity were matched in terms of age and gender with control cases who attended the tuberculosis clinic on the same day. Results of sensitivity test were obtained from record cards in the Microbiology Section. The method for determining the sensitivity test was absolute concentration. During the study period from January 1988 to December 1993, 798 patients were registered as having tuberculosis and HIV infection. Only 406 sensitivity tests were available before treatment and resisted to Isoniazid 56 (13.8%), rifampicin 36 (8.9%), ethambutol 6 (1.5%), streptomycin 64 (15.8%) and Multidrug resistant (MDR)- TB 11 (2.7%). In the control group, 475 tests were available and resisted to isoniazid 61 (12.8%), rifampicin 52 (10.9%), ethambutal 2 (0.4%), streptomycin 46 (9.7%) and MDR-TB 13 (2.7%). The prevalence of resistance to each drug was not significantly different except for streptomycin. We concluded that the prevalence of antituberculous drug resistance among Thai HIV-infected tuberculosis patients was not higher than among general tuberculosis patients.