Three-year follow-up of patients with pulmonary tuberculosis in Guinea-Bissau, West Africa.
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.
Winqvist
N
N
Dept. of Infectious Diseases, University Hospital of Malmö, Sweden.
Nauclér
A
A
Gomes
V
V
Djamanca
I
I
Koivula
T
T
Jensen
H
H
Dias
F
F
Biberfeld
G
G
Källenius
G
G
Norberg
R
R
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*
D000914:Antibodies, Viral; D000995:Antitubercular Agents