HIV and tuberculosis in rural sub-Saharan Africa: a cohort study with two year follow-up

被引:32
作者
Kelly, PM
Cumming, RG
Kaldor, JM
机构
[1] Univ Sydney, Dept Publ Hlth & Community Med, Sydney, NSW 2006, Australia
[2] St Johns Hosp, Mzuzu, Malawi
[3] Univ New S Wales, Natl Ctr HIV Epidemiol & Clin Res, Fac Med, Darlinghurst, NSW 2010, Australia
关键词
HIV; tuberculosis; chemotherapy; disease relapse; mortality; cure; sub-Saharan Africa; Malawi;
D O I
10.1016/S0035-9203(99)90025-1
中图分类号
R1 [预防医学、卫生学];
学科分类号
1004 ; 120402 ;
摘要
The objective was to examine the effect of HIV seropositivity on outcomes in tuberculosis (TB) patients in a rural African setting, including rates of TB relapse, other morbid events and mortality. The study setting was a district level hospital in Mzuzu, Malawi. Adult TB patients presenting between November 1991 and May 1993 were included in the study. Treatment was given according to national guidelines. Patients with smear-positive TB received 8 months of rifampicin-containing shea-course chemotherapy. Patients with smear-negative or extrapulmonary TB received 12 months of 'standard' treatment. Subjects were followed until they died or until the study concluded (December 1994). There were 225 eligible patients; 187 were tested for HIV and enrolled in the study (66.8% HIV seropositive). Ninety-four percent had complete follow-up information. The cure rate in smear-positive patients who survived to the end of treatment was over 90% and not significantly affected by HIV. Disorders of the gastrointestinal, neurological and dermatological systems were significantly more common in HIV-seropositive patients. HIV had a significant effect on the risk of relapse of TB (hazard ratio [HR] = 10.55 [95% CI 1.38, 80.93]) and on all-cause mortality (HR = 2.81 [95% CI 1.63, 4.64]). Despite high HIV prevalence, high rates of TB cure are achievable using the usual treatment protocols. However, excess TB relapse, other illnesses and mortality associated with HIV seropositivity have serious implications for TB control. There is an urgent need to identify effective intervention strategies aimed at prevention, early diagnosis and treatment of these illnesses.
引用
收藏
页码:287 / 293
页数:7
相关论文
共 38 条
[1]   RESPONSE TO TREATMENT, MORTALITY, AND CD4 LYMPHOCYTE COUNTS IN HIV-INFECTED PERSONS WITH TUBERCULOSIS IN ABIDJAN, COTE-DIVOIRE [J].
ACKAH, AN ;
COULIBALY, D ;
DIGBEU, H ;
DIALLO, K ;
VETTER, KM ;
COULIBALY, IM ;
GREENBERG, AE ;
DECOCK, KM .
LANCET, 1995, 345 (8950) :607-610
[2]   PULMONARY TUBERCULOSIS IN KIGALI, RWANDA - IMPACT OF HUMAN-IMMUNODEFICIENCY-VIRUS INFECTION ON CLINICAL AND RADIOGRAPHIC PRESENTATION [J].
BATUNGWANAYO, J ;
TAELMAN, H ;
DHOTE, R ;
BOGAERTS, J ;
ALLEN, S ;
VANDEPERRE, P .
AMERICAN REVIEW OF RESPIRATORY DISEASE, 1992, 146 (01) :53-56
[3]   COMPARISON OF 5 COMMERCIAL ENZYME-LINKED IMMUNOSORBENT ASSAYS AND WESTERN IMMUNOBLOTTING FOR HUMAN-IMMUNODEFICIENCY-VIRUS ANTIBODY DETECTION IN SERUM SAMPLES FROM CENTRAL AFRICA [J].
BEHETS, F ;
DISASI, A ;
RYDER, RW ;
BISHAGARA, K ;
PIOT, P ;
KASHAMUKA, M ;
KAMENGA, M ;
NZILA, N ;
LAGA, M ;
VERCAUTEREN, G ;
BATTER, V ;
BROWN, C ;
QUINN, T .
JOURNAL OF CLINICAL MICROBIOLOGY, 1991, 29 (10) :2280-2284
[4]   INFECTION AND MORBIDITY IN PATIENTS WITH TUBERCULOSIS IN NAIROBI, KENYA [J].
BRINDLE, RJ ;
NUNN, PP ;
BATCHELOR, BIF ;
GATHUA, SN ;
KIMARI, JN ;
NEWNHAM, RS ;
WAIYAKI, PG .
AIDS, 1993, 7 (11) :1469-1474
[5]   HIV INFECTION IN PATIENTS WITH TUBERCULOSIS IN KINSHASA, ZAIRE [J].
COLEBUNDERS, RL ;
RYDER, RW ;
NZILAMBI, N ;
DIKILU, K ;
WILLAME, JC ;
KABOTO, M ;
BAGALA, N ;
JEUGMANS, J ;
MUEPU, K ;
FRANCIS, HL ;
MANN, JM ;
QUINN, TC ;
PIOT, P .
AMERICAN REVIEW OF RESPIRATORY DISEASE, 1989, 139 (05) :1082-1085
[6]  
COX DR, 1972, J R STAT SOC B, V34, P187
[7]  
ELLIOTT AM, 1993, J TROP MED HYG, V96, P1
[8]   THE IMPACT OF HUMAN-IMMUNODEFICIENCY-VIRUS ON MORTALITY OF PATIENTS TREATED FOR TUBERCULOSIS IN A COHORT STUDY IN ZAMBIA [J].
ELLIOTT, AM ;
HALWIINDI, B ;
HAYES, RJ ;
LUO, N ;
MWINGA, AG ;
TEMBO, G ;
MACHIELS, L ;
STEENBERGEN, G ;
POBEE, JOM ;
NUNN, P ;
MCADAM, KPWJ .
TRANSACTIONS OF THE ROYAL SOCIETY OF TROPICAL MEDICINE AND HYGIENE, 1995, 89 (01) :78-82
[9]  
ELLIOTT AM, 1995, J TROP MED HYG, V98, P9
[10]  
ELLIOTT AM, 1992, Q J MED, V85, P855