The epidemiology of HIV-associated tuberculosis in rural Cambodia.
METHODS
Banteay Meanchey Province, Cambodia.


OBJECTIVE
The World Health Organization recommends human immunodeficiency virus (HIV) testing for all tuberculosis (TB) patients and TB screening for all HIV-infected persons in countries with a TB-HIV syndemic. We sought to determine whether evidence supports implementing these recommendations in South-East Asia.


METHODS
We conducted a cross-sectional survey and retrospective cohort study of patients newly diagnosed with HIV or TB from October 2003 to February 2005 to identify risk factors for HIV infection and TB, and for death during TB treatment.


RESULTS
HIV infection was diagnosed in 216/574 (38%) TB patients. TB disease was found in 124/450 (24%) HIV-infected persons. No sub-groups of patients had a low risk of HIV infection or TB. Of 180 TB patients with HIV infection and a recorded treatment outcome, 49 (27%) died compared to 17/357 (5%) without HIV infection (relative risk [RR] 5.2, 95% confidence interval [CI] 3.1-8.7). HIV-infected TB patients with smear-negative pulmonary disease died less frequently than those with smear-positive pulmonary disease (RR 0.39, 95%CI 0.16-0.93).


CONCLUSIONS
No sub-groups of patients had low risk for HIV infection or TB, and mortality among HIV-infected TB patients was high. These data justify using the WHO global TB-HIV recommendations in South-East Asia. Urgent interventions are needed to reduce the high mortality rate in HIV-infected TB patients.
Cain
K P
KP
Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA. kcain@cdc.gov
Kanara
N
N
Laserson
K F
KF
Vannarith
C
C
Sameourn
K
K
Samnang
K
K
Qualls
M L
ML
Wells
C D
CD
Varma
J K
JK
D017088:AIDS-Related Opportunistic Infections / Q000175:diagnosis / Q000453:epidemiology*; D000293:Adolescent; D000328:Adult; D002160:Cambodia / Q000453:epidemiology; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005260:Female; D006678:HIV / Q000302:isolation & purification*; D015658:HIV Infections / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology*; D006801:Humans; D008297:Male; D015995:Prevalence; D012044:Regression Analysis; D012307:Risk Factors; D012424:Rural Population; D013183:Sputum / Q000382:microbiology; D016896:Treatment Outcome; D014376:Tuberculosis / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology*