title: Tuberculosis with malaria or HIV co-infection in a large hospital in Luanda, Angola.
abstract: BACKGROUND
  Three major public health problems, tuberculosis, malaria and HIV/AIDS, are widespread in Angola, often as co-infections in the same individual. In 2009, it was assumed that 44,151 new cases of TB occurred in Angola. Interestingly, interventions such as treatment/prevention of malaria appear to reduce mortality in HIV-infected and possibly TB co-infected patients. However, despite the seriousness of the situation, current data on TB and co-infection rates are scarce. This study aimed to characterize all TB cases seen at the Hospital Sanatório de Luanda, and to determine the co-infection rate with HIV and/or malaria.
  
  
  METHODS
  This retrospective study collected demographic, diagnostic and clinical data from all patients admitted during 2007.
  
  
  RESULTS
  A total of 4,666 patients were admitted, of whom 1,906 (40.8%) were diagnosed with TB. Overall, 1,111 patients (58.3%) were male and most patients (n=1302, 68.3%) were adults (≥ 14 years). The rate of HIV co-infection was 37.4% (n=712). Malaria was diagnosed during admission and hospital stay in 714 patients (37.5%), with Plasmodium falciparum the predominant species. Overall mortality was 15.2% (n=290).
  
  
  CONCLUSIONS
  Because Luanda does not have the infrastructure to perform culture-based diagnosis of TB, confirmation of TB is problematic. The HIV-co-infection rate is high, with 37.4% of patients requiring integrated approaches to address this problem. With more than 1/3 of the TB patients co-infected with malaria, even during the hospital stay, the prevention of malaria in TB patients appears to be an effective way to reduce overall mortality.
authors.affiliation: Clínica Universitária de Doenças Infecciosas e Parasitárias, Faculdade de Medicina da Universidade de Lisboa, Portugal. evaladas@fm.ul.pt
authors.forename: Emília
authors.initials: E
authors.lastname: Valadas
authors.forename: Augusto
authors.initials: A
authors.lastname: Gomes
authors.forename: Ana
authors.initials: A
authors.lastname: Sutre
authors.forename: Sara
authors.initials: S
authors.lastname: Brilha
authors.forename: Afonso
authors.initials: A
authors.lastname: Wete
authors.forename: Thomas
authors.initials: T
authors.lastname: Hänscheid
authors.forename: Francisco
authors.initials: F
authors.lastname: Antunes
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000810:Angola / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D060085:Coinfection / Q000453:epidemiology*; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000453:epidemiology*; D006761:Hospitals; D006801:Humans; D007223:Infant; D016778:Malaria, Falciparum / Q000150:complications* / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012189:Retrospective Studies; D014376:Tuberculosis / Q000150:complications* / Q000453:epidemiology*; D055815:Young Adult