The bacteriology of pulmonary tuberculosis in a population with high human immunodeficiency virus seroprevalence

Int J Tuberc Lung Dis. 1998 Apr;2(4):312-6.


Setting: A public sector urban university hospital in Soweto, South Africa.

Objective: To describe the utility of sputum smear microscopy and the prevalence of Mycobacterium tuberculosis resistance to antituberculosis drugs according to human immunodeficiency virus (HIV) serostatus in adults.

Design: A retrospective descriptive study of consecutive cases using a record review.

Results: We studied 412 adults with culture-proven pulmonary tuberculosis, of whom 185 (44.9%) were HIV-seropositive and had a significantly lower sputum smear positivity than HIV seronegatives (68% versus 79%, P < 0.05). Smear positivity was significantly higher in HIV-infected patients with CD4 counts < or = 50/mm3 compared to those with CD4 counts of 201-300/mm3 (P < 0.05). In patients with and those without a history of previous treatment for tuberculosis, resistance to one or more antituberculosis drugs was found in 32.2% and 13.6% of cases, respectively, while resistance to both isoniazid and rifampicin (multidrug-resistant tuberculosis [MDR]) was found in 15.3% and 4.5% of patients, respectively. There was no significant difference in resistance between HIV-positive and seronegative patients.

Conclusion: A strong tuberculosis control programme and good surveillance will be required to prevent the further spread of MDR tuberculosis. Surveys such as these are useful for monitoring control programmes.

MeSH terms

  • AIDS-Related Opportunistic Infections / epidemiology
  • AIDS-Related Opportunistic Infections / microbiology*
  • Adult
  • Antitubercular Agents / therapeutic use*
  • CD4 Lymphocyte Count
  • Female
  • HIV Seroprevalence*
  • Humans
  • Male
  • Microbial Sensitivity Tests
  • Middle Aged
  • Mycobacterium tuberculosis / drug effects*
  • Mycobacterium tuberculosis / isolation & purification
  • Prevalence
  • South Africa / epidemiology
  • Sputum / microbiology
  • Tuberculosis, Multidrug-Resistant / epidemiology
  • Tuberculosis, Multidrug-Resistant / microbiology*
  • Tuberculosis, Pulmonary / epidemiology
  • Tuberculosis, Pulmonary / microbiology*


  • Antitubercular Agents