title: Three-year follow-up of patients with pulmonary tuberculosis in Guinea-Bissau, West Africa.
abstract: METHODS
  Raoul Follereau Hospital, Bissau, Guinea-Bissau.
  
  
  OBJECTIVE
  To study the long-term outcome of patients with bacteriologically verified tuberculosis (TB), with or without human immunodeficiency virus (HIV) co-infection.
  
  
  METHODS
  Sputum samples were collected from all patients referred to the hospital with clinical symptoms of pulmonary tuberculosis. Direct microscopy and culture was performed at the Health Laboratory. Patients with a culture positive for Mycobacterium tuberculosis were followed for 3 years, and underlying factors were analysed regarding the outcome of treatment. A group of sex and age-matched HIV-negative individuals was used as controls.
  
  
  RESULTS
  Of 206 bacteriologically verified pulmonary TB patients, 168 were followed up. Antibodies to HIV-2 were found in 33 patients (19.6%); eight patients (4.8%) had antibodies to HIV-1 or showed dual reactivity. Of 149 patients discharged to follow ambulatory treatment, the survival rate of HIV-2-positive patients was 42.3% (11/26) and for HIV-negative patients it was 81.9% (95/116). The difference in survival between HIV-2-positive and HIV-negative patients was highly significant (P < 0.00001). HIV-negative TB patients had a significantly higher mortality than their controls (mortality ratio 3.75, 95% confidence interval 1.58-8.90). Most patients who survived, regardless of HIV status, also became free from symptoms compatible wtih pulmonary TB.
  
  
  CONCLUSIONS
  Although the mortality rate among HIV-positive TB patients was very much higher than among HIV-negative patients, there are weighty arguments for active contact tracing and effective treatment of all TB patients.
authors.affiliation: Dept. of Infectious Diseases, University Hospital of Malmö, Sweden.
authors.forename: N
authors.initials: N
authors.lastname: Winqvist
authors.forename: A
authors.initials: A
authors.lastname: Nauclér
authors.forename: V
authors.initials: V
authors.lastname: Gomes
authors.forename: I
authors.initials: I
authors.lastname: Djamanca
authors.forename: T
authors.initials: T
authors.lastname: Koivula
authors.forename: H
authors.initials: H
authors.lastname: Jensen
authors.forename: F
authors.initials: F
authors.lastname: Dias
authors.forename: G
authors.initials: G
authors.lastname: Biberfeld
authors.forename: G
authors.initials: G
authors.lastname: Källenius
authors.forename: R
authors.initials: R
authors.lastname: Norberg
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000188:drug therapy* / Q000276:immunology / Q000382:microbiology / Q000401:mortality*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000914:Antibodies, Viral / Q000097:blood; D000995:Antitubercular Agents / Q000627:therapeutic use; D016022:Case-Control Studies; D002648:Child; D016358:Contact Tracing; D005260:Female; D005500:Follow-Up Studies; D006169:Guinea-Bissau / Q000453:epidemiology; D015497:HIV-1 / Q000276:immunology; D015498:HIV-2 / Q000276:immunology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013183:Sputum / Q000382:microbiology; D016019:Survival Analysis; D014397:Tuberculosis, Pulmonary / Q000188:drug therapy* / Q000276:immunology / Q000382:microbiology / Q000401:mortality*
chemical_list: D000914:Antibodies, Viral; D000995:Antitubercular Agents