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Free Content Predictors of incident tuberculosis among HIV-1-infected women in Tanzania

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Abstract:

SETTING: The development of tuberculosis (TB) in HIV-1-infected individuals is associated with accelerated HIV-1 disease progression.

OBJECTIVE: To examine the predictors of incident TB in HIV-1-infected Tanzanian women.

DESIGN: A prospective cohort of 1078 HIV-1-infected pregnant women was enrolled in a randomized clinical trial to examine the role of vitamin supplements in HIV-1 disease progression and fetal outcomes.

RESULTS: Of 1008 women evaluated for TB, 88 (8.7%) developed TB. After controlling for age, education and hemoglobin concentration, in multivariate analysis, low CD4 cell count, elevated erythrocyte sedimentation rate (ESR), decreased mid-upper arm circumference, and high viremia were associated with an increased risk of TB. CD4 <200 vs. ≥500 cells/mm3 was associated with a 4.44-fold increase in risk of TB (95%CI 2.10–9.40). Individuals with high viremia (≥50000 copies/ml) had a 2.43-fold increase in risk of TB (95%CI 1.24–4.76). Elevated malarial parasite density was slightly associated with a 65% (95%CI 19–85) decreased risk of TB.

CONCLUSIONS: The risk of developing TB was elevated among women with low CD4 cell counts, elevated ESR, coinfections with other pathogens, poor nutrition and high viremia. There is a slight inverse association between malarial infection and TB, possibly because treating malaria may reduce the risk of TB.

Keywords: CD4; HIV; TB; malaria; sub-Saharan Africa

Document Type: Regular Paper

Affiliations: 1: Department of Nutrition, Harvard School of Public Health, Boston, Massachusetts, USA; and Department of Immunology and Infectious Diseases, Harvard School of Public Health, Boston, Massachusetts, USA 2: Department of Biostatistics, Harvard School of Public Health, Boston, Massachusetts, USA 3: Department of Immunology and Infectious Diseases, Harvard School of Public Health, Boston, Massachusetts, USA; and Children's Hospital, Division of Infectious Diseases, Boston, Massachusetts, USA 4: Muhimbili University College of Health Sciences, Department of Community Health, Dar es Salaam, United Republic of Tanzania 5: Department of Nutrition, Harvard School of Public Health, Boston, Massachusetts, USA; and Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, USA

Publication date: October 1, 2005

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  • The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on tuberculosis and lung health world-wide.

    Certain IJTLD articles are selected for translation into French, Spanish, Chinese or Russian. They are available on the Union website

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