Incidence of tuberculosis and HIV and progression of silicosis and lung function impairment among former Basotho gold miners.
BACKGROUND
Pulmonary tuberculosis and HIV incidence, mortality, and the progression of silicosis and lung function impairment are described over a 1-year period in migrant ex-gold miners from Lesotho.


METHODS
Seven hundred seventy-nine Basotho miners were followed for 1 year starting 18 months after lay-off from a South African gold mine in 1998. At baseline and follow-up, they underwent a respiratory symptom interview, physical examination, HIV test, chest radiograph, and spirometry.


RESULTS
Five hundred thirteen of 779 (65.9%) participants attended both baseline and follow-up visits. HIV incidence was 5.4/100 person-years (95% CI: 3.4-8.2). Prevalence of silicosis (ILO score > or =1/1) was 26.6% at baseline and 27.0% at follow-up. Active tuberculosis diagnosed at baseline was a strong predictor of radiological progression of silicosis. Lung function as measured by FEV(1) declined an average of 91 ml between visits (95% CI: 67-116 ml). Calculated minimum incidence of tuberculosis was 3,085/100,000/years (95% CI: 1,797-4,940) at follow-up. Of those seen at baseline, 18 died before their scheduled follow-up visit (mean age: 51 years).


CONCLUSIONS
High rates of mortality and of HIV infection and pulmonary tuberculosis were found in this cohort after leaving the South African goldmines. Continuing lung function loss was also apparent. A partnership between the South African mining industry and governments in labor-sending areas of Southern Africa is needed to provide continuity of care and access to HIV and tuberculosis treatment and prevention services. Active silicosis surveillance and an improved statutory compensation system are also needed. These findings can serve as a baseline against which the impact of such interventions can be assessed.
Park
Harriet H
HH
International AIDS Vaccine Initiative, New York, New York, USA. hpark@iavi.org
Girdler-Brown
Brendan V
BV
Churchyard
Gavin J
GJ
White
Neil W
NW
Ehrlich
Rodney I
RI
D000328:Adult; D002423:Cause of Death; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D003906:Developing Countries; D018450:Disease Progression; D005500:Follow-Up Studies; D005541:Forced Expiratory Volume; D006046:Gold; D006679:HIV Seropositivity / Q000453:epidemiology* / Q000401:mortality; D006801:Humans; D015994:Incidence; D007927:Lesotho; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D008906:Mining; D029424:Pulmonary Disease, Chronic Obstructive / Q000453:epidemiology* / Q000401:mortality; D012829:Silicosis / Q000453:epidemiology* / Q000401:mortality; D016019:Survival Analysis; D014171:Transients and Migrants / Q000706:statistics & numerical data*; D014397:Tuberculosis, Pulmonary / Q000453:epidemiology* / Q000401:mortality; D014797:Vital Capacity
D006046:Gold