title: Tuberculosis and non-tuberculous mycobacteria among HIV-infected individuals in Ghana.
abstract: To assess the prevalence and clinical importance of previously unrecognised tuberculosis (TB) and isolation of non-tuberculous mycobacteria (NTM) among HIV-infected individuals in a teaching hospital in Ghana.
  
  
  
  Intensified mycobacterial case finding was conducted among HIV-positive individuals before initiation of antiretroviral therapy (ART). Data were collected on socio-demographic characteristics, medical history and TB-related signs and symptoms, and participants were followed for six months to determine treatment and vital status. Two sputum samples were obtained and examined for mycobacteria with smear microscopy, culture and Xpert MTB/RIF assay. NTM species were identified with the GenoType Mycobacterium CM/AS or sequence analysis of 16S rRNA gene.
  
  
  
  Of 473 participants, 60 (12.7%) had confirmed pulmonary TB, and 38 (8.0%) had positive cultures for NTM. Mycobacterium avium complex was identified in 9/38 (23.7%) of NTM isolates. Participants with NTM isolated were more likely to have CD4 cell count< 100 cells/μL (aOR 2.37; 95% CI: 1.10-5.14), BMI<18.5kg/m(2) (aOR 2.51; 95% CI: 1.15-5.51) and fever ≥2 weeks (aOR 2.76; 95% CI: 1.27-6.03) at baseline than participants with no mycobacteria. By six months, 76 (16.1%) participants had died; 20 (33.3%) with confirmed TB and 9 (23.7%) with NTM-positive culture. Mortality at six months was independently associated with TB diagnosis at enrolment (aHR 1.97; 95% CI 1.09-3.59), but not with NTM isolation after controlling for age, sex, CD4 cell count, BMI, prolonged fever and ART initiation.
  
  
  
  Intensified mycobacterial screening of HIV-infected individuals revealed a high burden of unrecognised pulmonary TB before ART initiation, which increased risk of death within six months. NTM were frequently isolated and associated with signs of poor clinical status but not with increased mortality.
authors.affiliation: Department of Infectious Diseases, Odense University Hospital, Odense, Denmark.|Institute of Clinical Research, University of Southern Denmark, Odense, Denmark.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Bjerrum
authors.affiliation: Fevers Unit, Department of Medicine, Korle-Bu Teaching Hospital, Accra, Ghana.
authors.forename: Joseph
authors.initials: J
authors.lastname: Oliver-Commey
authors.affiliation: Fevers Unit, Department of Medicine, Korle-Bu Teaching Hospital, Accra, Ghana.
authors.forename: Ernest
authors.initials: E
authors.lastname: Kenu
authors.affiliation: Fevers Unit, Department of Medicine, Korle-Bu Teaching Hospital, Accra, Ghana.
authors.forename: Margaret
authors.initials: M
authors.lastname: Lartey
authors.affiliation: Department of Medical Microbiology, University of Ghana, Accra, Ghana.
authors.forename: Mercy Jemima
authors.initials: MJ
authors.lastname: Newman
authors.affiliation: Department of Bacteriology, University of Ghana, Accra, Ghana.
authors.forename: Kennedy Kwasi
authors.initials: KK
authors.lastname: Addo
authors.affiliation: National Reference Centre for Mycobacteria, Research Centre Borstel, Sülfeld, Germany.
authors.forename: Doris
authors.initials: D
authors.lastname: Hilleman
authors.affiliation: Institute of Clinical Research, University of Southern Denmark, Odense, Denmark.|Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Denmark.
authors.forename: Aase Bengaard
authors.initials: AB
authors.lastname: Andersen
authors.affiliation: Department of Infectious Diseases, Odense University Hospital, Odense, Denmark.
authors.forename: Isik Somuncu
authors.initials: IS
authors.lastname: Johansen
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000453:epidemiology / Q000382:microbiology*; D000328:Adult; D018791:CD4 Lymphocyte Count; D005260:Female; D005838:Genotype; D005869:Ghana / Q000453:epidemiology; D015658:HIV Infections / Q000150:complications*; D006784:Hospitals, Teaching; D006801:Humans; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D009161:Mycobacterium / Q000235:genetics*; D009165:Mycobacterium Infections, Nontuberculous / Q000150:complications / Q000453:epidemiology* / Q000382:microbiology; D009170:Nontuberculous Mycobacteria / Q000235:genetics; D015995:Prevalence; D013183:Sputum / Q000382:microbiology; D014376:Tuberculosis / Q000150:complications / Q000453:epidemiology / Q000382:microbiology; D014397:Tuberculosis, Pulmonary / Q000150:complications / Q000453:epidemiology* / Q000382:microbiology
keywords: Ghana; HIV; Mortality; Non-tuberculous mycobacteria; Tuberculosis; VIH; micobacterias no tuberculosas; mortalidad; mortalité; mycobactéries non tuberculeuses; tuberculose