Tuberculosis and HIV infection association in a rural district of northern Uganda: epidemiological and clinical considerations
Migliori, G.B.; Borghesi, A.; Adriko, C.; Manfrin, V.; Okware, S.; Naamara, W.; Bartoloni, A.; Neri, M.; Acocella, G.
Tubercle and lung disease the official journal of the International Union against Tuberculosis and Lung Disease 73(5): 285-290
1992
ISSN/ISBN: 0962-8479 PMID: 1493236 DOI: 10.1016/0962-8479(92)90134-6Document Number: 328760
Between June 1987 and August 1989, physicians enrolled 323 tuberculosis (TB) patients and 116 health employees at the Arua Regional Hospital in a rural district of northern Uganda in a case control study. They wanted to look at the link between TB and HIV infection. TB patients were more likely to be HIV seropositive than the employees (18.3% vs. 7.7%; p .005). HIV seropositive individuals tended to be men (71.2% vs. 54.9% for controls; p .05) whose mean age was 27.69 years. Most HIV/TB patients lived in the town of Arua (50% vs. 7% in rural areas peripheral to Arua and 1.6% in a rural area near the district border; p .0001). HIV seropositive TB patients were more likely to have a sexually transmitted disease (STD) than HIV seronegative TB patients (47.4% vs. 12.5%; odds ratio [OR] = 6.32; p .0001), especially gonorrhea (p .0001). They also tended to have had more than 5 sexual partners in the past 2 years (mean number of partners among HIV seropositive TB patients = 10.6; 35.6% vs. 9.5%; OR = 9.24; p .0001). HIV seropositive TB patients were more likely to have participated in prostitution and to have had a blood transfusion than HIV seronegative TB patients (33.9% vs. 3.8%; OR = 13.03; p .001 and 6.8% vs. 1.1% OR = 6.33; p .05). Skin piercing, widely practiced in rural areas, appeared to have a protective effect against HIV infection (OR = .33; p .0005). HIV seropositive TB patients were significantly more likely to have a persistent cough of more than 4 months duration (p .001), fever lasting for more than 1 month (p .05), oral thrush (p .0001), lymphadenopathy (p .0005), and amenorrhea (fertile women only, p .005). 27 or 28 TB patients had AIDS. At the time of submission of this study for publication, 18 HIV seropositive TB patients died during treatment. The case fatality rate was indeed higher among HIV seropositive TB patients than among HIV seronegative TB patients (30.5% vs. 8.7%; p .0001). The TB-AIDS survival rate was 46.4% at 6 months, 32.1% at 12 months, and 21.4% at 16 months. Median survival time was 5 months.