The impact of human immunodeficiency virus on presentation and diagnosis of tuberculosis in a cohort study in Zambia.
Two hundred and forty-nine patients with tuberculosis were recruited to a cohort study to investigate the interaction between tuberculosis and HIV in Lusaka, Zambia; findings at presentation are presented here. One hundred and eighty-two (73%; 95% confidence interval 67-79%) of the cases were HIV-1 antibody positive. The diagnosis of tuberculosis was confirmed by microscopy for acid-alcohol fast bacilli, culture of Mycobacterium tuberculosis, or histology in 74% of all cases. HIV negative and positive cases differed in site of disease: among HIV negative patients 72% had pulmonary disease alone, 16% extrapulmonary disease alone and 12% had both, whereas among HIV positive patients 40% had pulmonary disease alone, 34% extrapulmonary disease alone and 26% both (P < 0.001). HIV negative and positive cases were compared with regard to outcome of diagnostic procedures: 55% of HIV negative cases could be diagnosed at enrollment by sputum smear, but only 35% of HIV positive cases (P < 0.01). Among pulmonary cases confirmed by sputum culture, 76% of HIV negative patients had a positive sputum smear, compared with 57% of HIV positive patients (P = 0.09). Pleural and pericardial disease were difficult to confirm, but culture of pleural fluid was positive in 12/46 HIV positive patients, compared with 0/11 HIV negative patients. Lymph node disease was readily confirmed by biopsy. The tuberculin test was positive in only 30/110 (27%) of HIV positive cases, but in 21/38 (55%) of HIV negative cases (P < 0.01). Mycobacterium tuberculosis was cultured in 57% of HIV negative cases and 54% of HIV positive cases; no atypical mycobacteria were isolated. Initial resistance to isoniazid was present in isolates from 5% of cases with a positive culture.
Elliott
A M
AM
School of Medicine, University of Zambia, Lusaka.
Halwiindi
B
B
Hayes
R J
RJ
Luo
N
N
Tembo
G
G
Machiels
L
L
Bem
C
C
Steenbergen
G
G
Pobee
J O
JO
Nunn
P P
PP
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D015331:Cohort Studies; D005260:Female; D015483:HIV Antibodies / Q000097:blood; D015658:HIV Infections / Q000150:complications* / Q000453:epidemiology; D015528:HIV Seroprevalence; D015497:HIV-1 / Q000276:immunology*; D006801:Humans; D008297:Male; D009169:Mycobacterium tuberculosis / Q000187:drug effects / Q000302:isolation & purification; D010496:Pericardium; D011446:Prospective Studies; D012737:Sex Factors; D013183:Sputum / Q000382:microbiology; D014374:Tuberculin Test; D014376:Tuberculosis / Q000150:complications* / Q000175:diagnosis; D014381:Tuberculosis, Cardiovascular / Q000150:complications / Q000175:diagnosis; D014396:Tuberculosis, Pleural / Q000150:complications / Q000175:diagnosis; D014397:Tuberculosis, Pulmonary / Q000150:complications / Q000175:diagnosis; D015024:Zambia / Q000453:epidemiology
D015483:HIV Antibodies