Impact of human immunodeficiency virus type 1 on tuberculosis in rural Haiti.
We conducted a case-control study to determine the relative and attributable risk of HIV seropositivity for bacillary-positive (smear and/or culture) pulmonary tuberculosis in Haiti. There were 274 patients with tuberculosis and an equal number of control subjects. Antibodies to HIV were present in 67 (24%) patients and eight (3%) control subjects. Odds ratios suggested that the risk of pulmonary tuberculosis was 15.7 times as great (95% confidence interval, 4.8 to 5.0; p less than 0.05) in patients 20 to 39 yr of age who were HIV-seropositive than in HIV-seronegative patients. In contrast, the relative risk in those 40 to 59 yr of age was elevated (3.0 times), though not significantly (lower 95% confidence interval, 0.8). In the 20- to 39-yr age group, 31% of tuberculosis was attributable to HIV infection (95% confidence interval between 23 and 39%). HIV-seropositive and HIV-seronegative patients did not differ with respect to sputum smear positivity. HIV-seronegative patients were twice as likely to be infected with resistant organisms, though this was not significant. We conclude that HIV infection is a major risk factor for pulmonary tuberculosis in young adult residents of Haiti. This, together with the fact that similar proportions of HIV-seropositive and HIV-seronegative patients were potentially infectious, suggests that without vigorous counteraction tuberculosis will become a greater problem for Haiti.
Long
R
R
Department of Medicine, Hôpital Albert Schweitzer, Deschapelles, Haiti.
Scalcini
M
M
Manfreda
J
J
Carré
G
G
Philippe
E
E
Hershfield
E
E
Sekla
L
L
Stackiw
W
W
D000163:Acquired Immunodeficiency Syndrome / Q000150:complications; D000328:Adult; D000995:Antitubercular Agents / Q000494:pharmacology; D016022:Case-Control Studies; D004352:Drug Resistance, Microbial; D005260:Female; D006679:HIV Seropositivity / Q000150:complications*; D015497:HIV-1; D006205:Haiti; D006801:Humans; D008297:Male; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000187:drug effects; D012424:Rural Population; D014397:Tuberculosis, Pulmonary / Q000150:complications*
D000995:Antitubercular Agents