Impact of human immunodeficiency virus infection on tuberculosis in Kigali, Rwanda: One-year study of 377 consecutive cases

Objectives: To analyze and compare the clinical, diagnostic, and therapeutic features of tuberculosis (TB) in human immunodeficiency virus (HIV)-seropositive and seronegative patients, Methods: A 1 -year retrospective review of medical records and charts of TB patients admitted to and followed-up at the Department of Internal Medicine of the Centre Hospitalier de Kigali (CHK), Kigali, Rwanda.Results: Tuberculosis was diagnosed in 510 patients.Complete data, including HIV serologic testing, were available for 377 patients (74%) of whom 227 were male and 150 female, aged 17-70 years (mean, 33 y).Human immunodeficiency virus antibodies were detected in 334 (88.6%) of the 377 evaluable patients.A definite diagnosis of TB was established in similar proportions of Hlkeropositive (66%) and HIV-seronegative (63%) patients.The HIV-infected patients differed from the patients without HIV infection in the following features: proportion of patients in the age group 20-39 years (80% vs. 58%; P = O.OOl), extrapulmonary manifestations (56% vs. 40%; P = 0.045), lower/middle lobe infiltrates (18% vs. 6%; P = 0.07), presence of cavities (15% vs. 34%; P = 0.002), pleural disease (23 vs. 12%; P = 0.08), tuberculin anergy (67% vs. 26%; P < 0.001).After 6 months of anti-TB therapy, both HIV-infected and HIV-uninfected patients with smear positive pulmonary TB had their sputum samples cleared of acid-fast organisms.Adverse drug reactions occurred in 16% and 7% of HIVseropositive and seronegative patients, respectively (P = 0.1 1).