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The impact of human immunodeficiency virus on mortality of patients treated for tuberculosis in a cohort study in Zambia

Identifieur interne : 002918 ( Istex/Corpus ); précédent : 002917; suivant : 002919

The impact of human immunodeficiency virus on mortality of patients treated for tuberculosis in a cohort study in Zambia

Auteurs : Alison M. Elliott ; Benita Halwiindi ; Richard J. Hayes ; Nkandu Luo ; Alwyn G. Mwinga ; George Tembo ; Lieve Machiels ; Ger Steenbergen ; Joseph O. M. Pobee ; Paul Nunn ; Keith P. W. J. Mcadam

Source :

RBID : ISTEX:7DF38C617359C35713F86721C258FBBC7B2BD023

English descriptors

Abstract

We have examined the impact of human immunodeficiency virus (HIV) on mortality of patients treated for tuberculosis in a prospective study in Lusaka, Zambia. Patients with sputum smear-positive, miliary, or meningeal tuberculosis were prescribed 2 months' daily streptomycin, thiacetazone, isoniazid, rifampicin, and pyrazinamide followed by 6 months thiacetazone and isoniazid; others, 2 months streptomycin, thiacetazone and isoniazid followed by 10 months thiacetazone and isoniazid. 239 patients (65 HIV-negative and 174 HIV-positive) were followed to 2 years from start of treatment. The crude mortality rate ratio for HIV-positive compared with HIV-negative patients over 2 years was 5.00 (95% confidence interval 2.30–10.86). Median survival for HIV-positive patients from the start of treatment was 22 months. At least 34% of HIV-positive patients for whom cause of death was known died from tuberculosis, three-quarters of these during the first month of treatment. Risk factors for death in HIV-positive patients included multi-site tuberculosis, history of prolonged diarrhoea or fever, oral thrush, splenomegaly, anergy to tuberculin, low weight, anaemia or lymphopenia, and poor compliance with regimens containing rifampicin and pyrazinamide. Tuberculosis, even treated, was a major cause of death in patients with HIV infection.

Url:
DOI: 10.1016/0035-9203(95)90668-1

Links to Exploration step

ISTEX:7DF38C617359C35713F86721C258FBBC7B2BD023

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<idno type="pISSN">0035-9203</idno>
<idno type="eISSN">1878-3503</idno>
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<publisher>Royal Society of Tropical Medicine and Hygiene</publisher>
<date type="published" when="1995-01"></date>
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<biblScope unit="issue">1</biblScope>
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<date>1995</date>
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<p>We have examined the impact of human immunodeficiency virus (HIV) on mortality of patients treated for tuberculosis in a prospective study in Lusaka, Zambia. Patients with sputum smear-positive, miliary, or meningeal tuberculosis were prescribed 2 months' daily streptomycin, thiacetazone, isoniazid, rifampicin, and pyrazinamide followed by 6 months thiacetazone and isoniazid; others, 2 months streptomycin, thiacetazone and isoniazid followed by 10 months thiacetazone and isoniazid. 239 patients (65 HIV-negative and 174 HIV-positive) were followed to 2 years from start of treatment. The crude mortality rate ratio for HIV-positive compared with HIV-negative patients over 2 years was 5.00 (95% confidence interval 2.30–10.86). Median survival for HIV-positive patients from the start of treatment was 22 months. At least 34% of HIV-positive patients for whom cause of death was known died from tuberculosis, three-quarters of these during the first month of treatment. Risk factors for death in HIV-positive patients included multi-site tuberculosis, history of prolonged diarrhoea or fever, oral thrush, splenomegaly, anergy to tuberculin, low weight, anaemia or lymphopenia, and poor compliance with regimens containing rifampicin and pyrazinamide. Tuberculosis, even treated, was a major cause of death in patients with HIV infection.</p>
</abstract>
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<head>Keywords</head>
<item>
<term>HIV</term>
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<item>
<term>tuberculosis</term>
</item>
<item>
<term>Zambia</term>
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<journal-id journal-id-type="publisher-id">trstmh</journal-id>
<journal-title>Transactions of The Royal Society of Tropical Medicine and Hygiene</journal-title>
<abbrev-journal-title>Trans R Soc Trop Med Hyg</abbrev-journal-title>
<issn pub-type="ppub">0035-9203</issn>
<issn pub-type="epub">1878-3503</issn>
<publisher>
<publisher-name>Royal Society of Tropical Medicine and Hygiene</publisher-name>
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<article-id pub-id-type="doi">10.1016/0035-9203(95)90668-1</article-id>
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<subj-group subj-group-type="heading">
<subject>Articles</subject>
</subj-group>
</article-categories>
<title-group>
<article-title>The impact of human immunodeficiency virus on mortality of patients treated for tuberculosis in a cohort study in Zambia</article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author" corresp="yes">
<name>
<surname>Elliott</surname>
<given-names>Alison M.</given-names>
</name>
<xref ref-type="corresp" rid="COR1">
<sup></sup>
</xref>
<xref ref-type="aff" rid="AFF1">
<sup>1</sup>
</xref>
<xref ref-type="aff" rid="AFF2">
<sup>2</sup>
</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Halwiindi</surname>
<given-names>Benita</given-names>
</name>
<xref ref-type="aff" rid="AFF1">
<sup>1</sup>
</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Hayes</surname>
<given-names>Richard J.</given-names>
</name>
<xref ref-type="aff" rid="AFF2">
<sup>2</sup>
</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Luo</surname>
<given-names>Nkandu</given-names>
</name>
<xref ref-type="aff" rid="AFF1">
<sup>1</sup>
</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Mwinga</surname>
<given-names>Alwyn G.</given-names>
</name>
<xref ref-type="aff" rid="AFF1">
<sup>1</sup>
</xref>
<xref ref-type="aff" rid="AFF2">
<sup>2</sup>
</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Tembo</surname>
<given-names>George</given-names>
</name>
<xref ref-type="aff" rid="AFF1">
<sup>1</sup>
</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Machiels</surname>
<given-names>Lieve</given-names>
</name>
<xref ref-type="aff" rid="AFF1">
<sup>1</sup>
</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Steenbergen</surname>
<given-names>Ger</given-names>
</name>
<xref ref-type="aff" rid="AFF3">
<sup>3</sup>
</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Pobee</surname>
<given-names>Joseph O.M.</given-names>
</name>
<xref ref-type="aff" rid="AFF1">
<sup>1</sup>
</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Nunn</surname>
<given-names>Paul</given-names>
</name>
<xref ref-type="aff" rid="AFF2">
<sup>2</sup>
</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>McAdam</surname>
<given-names>Keith P.W.J.</given-names>
</name>
<xref ref-type="aff" rid="AFF2">
<sup>2</sup>
</xref>
</contrib>
<aff id="AFF1">
<label>1</label>
School of Medicine, University of Zambia, Lusaka, Zambia</aff>
<aff id="AFF2">
<label>2</label>
London School of Hygiene and Tropical Medicine, London, UK</aff>
<aff id="AFF3">
<label>3</label>
The Netherlands Development Corporation, do The Netherlands Embassy, Harare, Zimbabwe</aff>
</contrib-group>
<author-notes>
<fn>
<p>Clinical studies and pathology</p>
</fn>
<corresp id="COR1">
<label></label>
Address for correspondence: A. M. Elliott, University of Colorado Health Sciences Center, Infectious Disease Division, 4200 East Ninth Avenue, Denver, Colorado 80262, USA.</corresp>
</author-notes>
<pub-date pub-type="ppub">
<month>1</month>
<year>1995</year>
</pub-date>
<volume>89</volume>
<issue>1</issue>
<fpage>78</fpage>
<lpage>82</lpage>
<history>
<date date-type="received">
<day>17</day>
<month>3</month>
<year>1994</year>
</date>
<date date-type="rev-recd">
<day>16</day>
<month>5</month>
<year>1994</year>
</date>
<date date-type="accepted">
<day>17</day>
<month>5</month>
<year>1994</year>
</date>
</history>
<permissions>
<copyright-year>1995</copyright-year>
</permissions>
<abstract>
<title>Abstract</title>
<p>We have examined the impact of human immunodeficiency virus (HIV) on mortality of patients treated for tuberculosis in a prospective study in Lusaka, Zambia. Patients with sputum smear-positive, miliary, or meningeal tuberculosis were prescribed 2 months' daily streptomycin, thiacetazone, isoniazid, rifampicin, and pyrazinamide followed by 6 months thiacetazone and isoniazid; others, 2 months streptomycin, thiacetazone and isoniazid followed by 10 months thiacetazone and isoniazid. 239 patients (65 HIV-negative and 174 HIV-positive) were followed to 2 years from start of treatment. The crude mortality rate ratio for HIV-positive compared with HIV-negative patients over 2 years was 5.00 (95% confidence interval 2.30–10.86). Median survival for HIV-positive patients from the start of treatment was 22 months. At least 34% of HIV-positive patients for whom cause of death was known died from tuberculosis, three-quarters of these during the first month of treatment. Risk factors for death in HIV-positive patients included multi-site tuberculosis, history of prolonged diarrhoea or fever, oral thrush, splenomegaly, anergy to tuberculin, low weight, anaemia or lymphopenia, and poor compliance with regimens containing rifampicin and pyrazinamide. Tuberculosis, even treated, was a major cause of death in patients with HIV infection.</p>
</abstract>
<kwd-group xml:lang="en">
<title>Keywords</title>
<kwd>HIV</kwd>
<kwd>tuberculosis</kwd>
<kwd>Zambia</kwd>
</kwd-group>
<custom-meta-wrap>
<custom-meta>
<meta-name>cover-date</meta-name>
<meta-value>January-February 1995</meta-value>
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</front>
<back>
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<title>The impact of human immunodeficiency virus on mortality of patients treated for tuberculosis in a cohort study in Zambia</title>
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<title>The impact of human immunodeficiency virus on mortality of patients treated for tuberculosis in a cohort study in Zambia</title>
</titleInfo>
<name type="personal" displayLabel="corresp">
<namePart type="given">Alison M.</namePart>
<namePart type="family">Elliott</namePart>
<affiliation>School of Medicine, University of Zambia, Lusaka, Zambia</affiliation>
<affiliation>London School of Hygiene and Tropical Medicine, London, UK</affiliation>
<affiliation>Address for correspondence: A. M. Elliott, University of Colorado Health Sciences Center, Infectious Disease Division, 4200 East Ninth Avenue, Denver, Colorado 80262, USA.</affiliation>
<role>
<roleTerm type="text">author</roleTerm>
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<name type="personal">
<namePart type="given">Benita</namePart>
<namePart type="family">Halwiindi</namePart>
<affiliation>School of Medicine, University of Zambia, Lusaka, Zambia</affiliation>
<role>
<roleTerm type="text">author</roleTerm>
</role>
</name>
<name type="personal">
<namePart type="given">Richard J.</namePart>
<namePart type="family">Hayes</namePart>
<affiliation>London School of Hygiene and Tropical Medicine, London, UK</affiliation>
<role>
<roleTerm type="text">author</roleTerm>
</role>
</name>
<name type="personal">
<namePart type="given">Nkandu</namePart>
<namePart type="family">Luo</namePart>
<affiliation>School of Medicine, University of Zambia, Lusaka, Zambia</affiliation>
<role>
<roleTerm type="text">author</roleTerm>
</role>
</name>
<name type="personal">
<namePart type="given">Alwyn G.</namePart>
<namePart type="family">Mwinga</namePart>
<affiliation>School of Medicine, University of Zambia, Lusaka, Zambia</affiliation>
<affiliation>London School of Hygiene and Tropical Medicine, London, UK</affiliation>
<role>
<roleTerm type="text">author</roleTerm>
</role>
</name>
<name type="personal">
<namePart type="given">George</namePart>
<namePart type="family">Tembo</namePart>
<affiliation>School of Medicine, University of Zambia, Lusaka, Zambia</affiliation>
<role>
<roleTerm type="text">author</roleTerm>
</role>
</name>
<name type="personal">
<namePart type="given">Lieve</namePart>
<namePart type="family">Machiels</namePart>
<affiliation>School of Medicine, University of Zambia, Lusaka, Zambia</affiliation>
<role>
<roleTerm type="text">author</roleTerm>
</role>
</name>
<name type="personal">
<namePart type="given">Ger</namePart>
<namePart type="family">Steenbergen</namePart>
<affiliation>The Netherlands Development Corporation, do The Netherlands Embassy, Harare, Zimbabwe</affiliation>
<role>
<roleTerm type="text">author</roleTerm>
</role>
</name>
<name type="personal">
<namePart type="given">Joseph O.M.</namePart>
<namePart type="family">Pobee</namePart>
<affiliation>School of Medicine, University of Zambia, Lusaka, Zambia</affiliation>
<role>
<roleTerm type="text">author</roleTerm>
</role>
</name>
<name type="personal">
<namePart type="given">Paul</namePart>
<namePart type="family">Nunn</namePart>
<affiliation>London School of Hygiene and Tropical Medicine, London, UK</affiliation>
<role>
<roleTerm type="text">author</roleTerm>
</role>
</name>
<name type="personal">
<namePart type="given">Keith P.W.J.</namePart>
<namePart type="family">McAdam</namePart>
<affiliation>London School of Hygiene and Tropical Medicine, London, UK</affiliation>
<role>
<roleTerm type="text">author</roleTerm>
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</name>
<typeOfResource>text</typeOfResource>
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<publisher>Royal Society of Tropical Medicine and Hygiene</publisher>
<dateIssued encoding="w3cdtf">1995-01</dateIssued>
<copyrightDate encoding="w3cdtf">1995</copyrightDate>
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<abstract>We have examined the impact of human immunodeficiency virus (HIV) on mortality of patients treated for tuberculosis in a prospective study in Lusaka, Zambia. Patients with sputum smear-positive, miliary, or meningeal tuberculosis were prescribed 2 months' daily streptomycin, thiacetazone, isoniazid, rifampicin, and pyrazinamide followed by 6 months thiacetazone and isoniazid; others, 2 months streptomycin, thiacetazone and isoniazid followed by 10 months thiacetazone and isoniazid. 239 patients (65 HIV-negative and 174 HIV-positive) were followed to 2 years from start of treatment. The crude mortality rate ratio for HIV-positive compared with HIV-negative patients over 2 years was 5.00 (95% confidence interval 2.30–10.86). Median survival for HIV-positive patients from the start of treatment was 22 months. At least 34% of HIV-positive patients for whom cause of death was known died from tuberculosis, three-quarters of these during the first month of treatment. Risk factors for death in HIV-positive patients included multi-site tuberculosis, history of prolonged diarrhoea or fever, oral thrush, splenomegaly, anergy to tuberculin, low weight, anaemia or lymphopenia, and poor compliance with regimens containing rifampicin and pyrazinamide. Tuberculosis, even treated, was a major cause of death in patients with HIV infection.</abstract>
<note type="footnotes">Clinical studies and pathology</note>
<note type="author-notes">∗Address for correspondence: A. M. Elliott, University of Colorado Health Sciences Center, Infectious Disease Division, 4200 East Ninth Avenue, Denver, Colorado 80262, USA.</note>
<subject lang="en">
<genre>Keywords</genre>
<topic>HIV</topic>
<topic>tuberculosis</topic>
<topic>Zambia</topic>
</subject>
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<title>Transactions of The Royal Society of Tropical Medicine and Hygiene</title>
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<title>Trans R Soc Trop Med Hyg</title>
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<identifier type="eISSN">1878-3503</identifier>
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<part>
<date>1995</date>
<detail type="volume">
<caption>vol.</caption>
<number>89</number>
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<caption>no.</caption>
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<start>78</start>
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