title: Effect of HIV-1 infection on tuberculosis and fertility in a large workforce in Kinshasa, Democratic Republic of the Congo.
abstract: To determine the effect of an HIV counseling service on the incidence of HIV and tuberculosis infection and on the fertility rate in a large workforce cohort of adult men and women from Kinshasa, Democratic Republic of Congo (formerly Zaire), we conducted a 2-year prospective longitudinal cohort study, two large Kinshasa businesses (a commercial bank and a textile factory). We determined baseline HIV-1 seroprevalence, HIV-1 and tuberculosis mortality/morbidity, and fertility rates during 24 months of follow-up on 8866 employees and 6411 wives of male employees. The baseline HIV-1 seroprevalence was 2.8% in male employees (n = 6657), 8.4% in female employees (n = 417), and 2.4% in the wives of male employees (n = 4692). The HIV-1 seroincidence per 100 person-years of follow-up in these three groups was 0.9, 0.5 and 0.8, respectively. The incidence of tuberculosis was 2.4/100 person years in persistently seropositive individuals compared with a 0.38 rate in persistently seronegative individuals (p < 0.01). The annual fertility rate in persistently seronegative women was 250.0/1000 women compared with a rate of 140/1000 in persistently seropositive women (p < 0.001). Forty-eight (44%) of 105 male employees and 17 (26%) of 60 wives of male workers who died during follow-up were HIV-1 seropositive. HIV infection was responsible for nearly one half of all deaths in this large workforce. Tuberculosis incidence was six times higher in HIV-1-infected compared with uninfected individuals. Counseling of HIV-infected women and their husbands appeared to be effective as their cumulative fertility rate was 44% lower than the rate in similarly aged uninfected women.
authors.affiliation: Project SIDA, Kinshasa, Democratic Republic of Congo. robert.ryder@yale.edu
authors.forename: R W
authors.initials: RW
authors.lastname: Ryder
authors.forename: V
authors.initials: V
authors.lastname: Batter
authors.forename: N
authors.initials: N
authors.lastname: Kaseka
authors.forename: F
authors.initials: F
authors.lastname: Behets
authors.forename: D
authors.initials: D
authors.lastname: Sequeira
authors.forename: E
authors.initials: E
authors.lastname: M'Boly
authors.forename: M
authors.initials: M
authors.lastname: Kanda
authors.forename: M
authors.initials: M
authors.lastname: Tshibambe
authors.forename: M
authors.initials: M
authors.lastname: Morgan
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control*; D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D001723:Birth Rate / Q000639:trends*; D015331:Cohort Studies; D003376:Counseling; D015023:Democratic Republic of the Congo / Q000453:epidemiology; D003906:Developing Countries; D004651:Employment / Q000706:statistics & numerical data; D005260:Female; D015528:HIV Seroprevalence; D015497:HIV-1 / Q000302:isolation & purification*; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011336:Probability; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D017678:Sex Distribution; D015996:Survival Rate; D014376:Tuberculosis / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control*