Tuberculosis chemotherapy and sputum conversion among HIV-seropositive and HIV-seronegative patients in south-eastern Uganda.

OBJECTIVE: To investigate if there is a difference in response to tuberculosis treatment between HIV seronegative and HIV seropositive patients following two months of intensive phase tuberculosis treatment. DESIGN: Prospective cohort study. SETTING: St. Francis Leprosy Centre, south-east Uganda. SUBJECTS: Four hundred fifty seven patients with never previously treated sputum smear-positive tuberculosis admitted during a two-year period in 1991/1993. INTERVENTION: Intensive phase treatment with streptomycin, isoniazid, rifampicin and pyrazinamide. MAIN OUTCOME MEASURES: Sputum conversion from a positive to a negative smear at eight weeks of treatment. RESULTS: HIV seropositivity prevalence was 28%. Among HIV seronegative patients, conversion to a negative smear status occurred in 76% persons compared to 78% in HIV seropositive patients. This difference was not statistically significant (OR = 0.9; 95% CI, 0.6-1.5). HIV seropositive patients, however, were more likely to die (p = 0.017). A high prevalence of resistance to isoniazid and streptomycin was found. Isoniazid resistance was more likely in HIV seronegative patients with M. tuberculosis strains compared to HIV seropositive persons (p < 0.005). Initial resistance to antituberculosis drugs did not have a significant effect on smear conversion. CONCLUSION: This study demonstrates that HIV-seropositive status is not a principal factor in delaying sputum conversion among patients receiving intensive phase tuberculosis treatment.

PIP: A prospective cohort study was undertaken to investigate the response of HIV-seropositive and -seronegative patients at St. Francis Leprosy Center, southeastern Uganda, to tuberculosis chemotherapy. The study population included 457 patients without a history of prior tuberculosis therapy between 1991 and 1993. The subjects were exposed to an intensive phase therapy of rifampicin, streptomycin, isoniazid, and pyrazinamide. After the treatment, sputum culture and sensitivity tests were conducted. Findings showed that 77% of the patients who never received tuberculosis treatment in the past converted to a negative smear status after the 8-week treatment. There was no significant difference in sputum conversion rates between HIV-seropositive and -seronegative patients. The study also revealed that HIV seropositivity prevalence was 28%. Among HIV-seronegative patients, conversion to a negative smear status occurred in 76% compared to 78% HIV-seropositive patients. Moreover, a significant number of HIV-seronegative patients died during the initial course of the therapy. Also, a high prevalence of isoniazid and streptomycin resistance was noted; however, this result never affected the conversions of smears. In conclusion, the study clearly demonstrates that other factors outside the seropositive status may be the principal causes of the delay in sputum conversion among patients receiving intensive tuberculosis chemotherapy.

Leprosy and infection with the human immunodeficiency virus in Uganda; a case-control study.

Both leprosy and infection with the human immunodeficiency virus (HIV) are endemic in Uganda. Various speculations about a possible interaction between the two infections have been put forward but not confirmed. A case-control study involving 189 new leprosy patients and 481 matched controls, resident in eight Ugandan districts, was carried out to investigate if any relationship exists between leprosy and infection with HIV-1 in Uganda. Serum samples from 23 (12.2%) of the 189 leprosy patients tested positive for HIV-1 antibodies as compared to 88 (18.3%) of the 481 control sera. The two proportions of HIV seropositivity are not different statistically. A stratified analysis of the data by districts was done and showed a negative relationship between leprosy and HIV infection in the case of Rakai District (0.04 < odds ratio < 0.61, p = 0.002). It is recommended that studies seeking to observe the clinical progress of dually infected patients might help to reveal new knowledge about a possible relationship between HIV and leprosy and about the immunology of leprosy in general.

Type 1 reactions in leprosy, neuritis and steroid therapy: the impact of the human immunodeficiency virus.

The incidence of type 1 reactions and neuritis among HIV seronegative and HIV seropositive leprosy patients was investigated. HIV seropositivity was associated with an increased incidence of type 1 reactions among multibacillary (MB) patients, which were observed in 9 of 12 seropositive MB patients and in 8 of 40 HIV seronegative MB patients (P < 0.0005). Similarly, the incidence of neuritis was significantly increased among the HIV seropositive MB patients, of whom 8 developed acute neuritis compared to 3 of the HIV seronegative patients (P < 0.0005). There was no significant difference between the numbers of paucibacillary HIV seropositive and HIV seronegative patients who developed these complications. Both the HIV seronegative and HIV seropositive patients showed a similar response to steroid therapy for the management of acute neuritis.

Hospital-based epidemiological study of reactions, Buluba Hospital, 1985-89.

A retrospective study of 256 reactional episodes, both reversal reaction and erythema nodosum leprosum (ENL), seen in Buluba Hospital over a 5-year period (1985-89) was made. Over 90% of these episodes were due to reversal reaction, with ENL being encountered infrequently. About 80% of reversal reactions occurred during chemotherapy but all the episodes of ENL occurred during this period. Over 70% of both reversal and ENL episodes presented with clinically apparent nerve and skin involvement. The need to assess the effect of multidrug therapy on the incidence of reactions and to develop more sensitive diagnostic tools to detect early neuritis is emphasized. It is also necessary to study those patients who develop recurrent reactional episodes.

Human immunodeficiency virus and leprosy--type 1 reactions, nerve damage and steroid therapy: 'a case report'.

In this study a 28-year-old female with both BL leprosy and HIV infections is discussed. Her clinical progress was followed until she completed MDT. During this period she developed recurrent reactional episodes, nerve damage and intercurrent illnesses--some of which might have been due to steroids.

Hospital-based study on neonatal tetanus, Buluba Hospital, 1985-1989.

Neonatal tetanus is a major cause of morbidity and mortality among neonates in Uganda. A retrospective study has been made of 228 cases of neonatal tetanus seen in Buluba Hospital over the 5-year period of 1985-1989. The number of cases of neonatal tetanus admitted per year to the hospital did not decrease significantly during that period suggesting that the immunization programme aimed at immunization of pregnant women with tetanus toxoid has not had a clear impact. Over 40% of neonatal tetanus cases came from the two nearest subcounties: Waina and Imanyiro. Over 75% of admitted cases of neonatal tetanus accounted for 23% of all deaths among child admissions. More than 90% of neonatal tetanus cases showed the first symptoms of the illness within the first 14 days of life; the shortest incubation period was 2 days. The average age at onset was 5.6 days and the average age at death was 9.9 days. The need for a more effective immunization programme and more intensified activities to increase the proportion of deliveries attended by trained personnel and improve hygienic conditions during and after deliveries is emphasized.

Hospital-based study on neonatal tetanus; Buluba Hospital; 1985-1989

Neonatal tetanus is a major cause of morbidity and mortality among neonates in Uganda. A retrospective study has been made of 228 cases of neonatal tetanus seen in Buluba Hospital over the 5-year period of 1985-1989. The number of cases of neonatal tetanus admitted per year to the hospital did not decrease significantly during that period suggesting that the immunization programme aimed at immunization of pregnant women with tetanus toxoid has not had a clear impact. Over 40pc of neonatal tetanus cases came from the two nearest subcounties: Waina and Imanyiro. Over 75pc of admitted cases of neonatal tetanus accounted for 23pc of all deaths among child admissions. More than 90pc of neonatal tetanus cases showed the first symptoms of the illness within the first 14 days of life; the shortest incubation period was 2 days. The average age at onset was 5.6 days and the average age at death was 9.9 days. The need for a more effective immunization programme and more intensified activities to increase the proportion of deliveries attended by trained personnel and improve hygienic conditions during and after deliveries is emphasized

Management of HIV infected leprosy patients

This paper will attempt to review literature relevant to aspects of chemotherapy of HIV infected leprosy patients