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Home / The International Journal of Tuberculosis and Lung Disease, Volume 9, Number 10

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

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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: 01 October 2005

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  • The International Journal of Tuberculosis and Lung Disease (IJTLD) is for clinical research and epidemiological studies on lung health, including articles on TB, TB-HIV and respiratory diseases such as COVID-19, asthma, COPD, child lung health and the hazards of tobacco and air pollution. Individuals and institutes can subscribe to the IJTLD online or in print – simply email us at [email protected] for details.

    The IJTLD is dedicated to understanding lung disease and to the dissemination of knowledge leading to better lung health. To allow us to share scientific research as rapidly as possible, the IJTLD is fast-tracking the publication of certain articles as preprints prior to their publication. Read fast-track articles.

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