Treatment of tuberculosis in HIV-infected patients in Zaire [letter]

In many developing countries the rates of cure without relapse in tuberculosis patients 91% overall and 87% in those infected with human immunodeficiency virus (HIV) who survived and were treated for 6 months that were seen in the study of Perriens and colleagues would reflect great success. The question is whether this level of compliance could be reached outside the research setting. The 6-month regimen was significantly less effective than the 12-month regimen in HIV-positive patients. This suggests that 6 months of drug therapy is insufficient or that the intermittent administration of drugs is unsatisfactory in treating this group. However if incomplete compliance interfered with the implementation of the regimen the treatment program rather than the efficacy of the drugs was being tested. That this was the case is supported by the recurrence rate in the HIV-negative group; it was higher than would be expected if compliance was complete and it was not significantly different from that in the HIV-positive group treated for 6 months. In Zambia occasionally difficult cases require directly observed intermittent therapy but compliance is impeded because patients cannot make the difficult trip to the clinic. Compliance with a daily regimen of streptomycin during the intensive phase of outpatient therapy is poorer than a regimen of oral drugs taken outside the clinic according to patient reports. The urban population of Lusaka Zambia is very mobile and patients often fail to appear for their tuberculosis treatment for a week or more.