SETTING: Two tuberculosis (TB) reference hospitals in Maputo, Mozambique. OBJECTIVES: To assess the pattern of TB drug resistance and its risk factors in human immunodeficiency virus (HIV) patients. DESIGN: Adult HIV-positive patients with TB diagnosed by culture of sputum or bronchial washing were enrolled during 2002-2003. Cultures of 111 patients were tested for rifampicin, isoniazid, streptomycin and ethambutol sensitivity. Chest X-ray, haemoglobin (Hb), total lymphocyte and CD4 counts were also performed. RESULTS: Overall resistance to any drugs was found in 18% and multidrug-resistant TB (MDR-TB) in 9%. New cases of TB accounted for 62% of the studied group. Drug resistance in this subgroup was 13% compared with 26.3% in the previously treated subgroup, and MDR-TB was 5.8% vs. 15.8%. All patients presented Hb levels < 9 g/dl and total lymphocyte counts < 1200/mu l. CD4 counts were significantly low in the drug resistance subgroup, with levels mostly < 100/mu l. Cavities on X-ray were seen only in drug-sensitive patients. No risk factors for drug resistance were detected. CONCLUSIONS: Overall observed drug resistance was 18%, and MDR-TB 9%. Previously treated patients had high drug resistance (26.3%) and MDR-TB (15.8%).95494500