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Free Content The epidemiology of HIV-associated tuberculosis in rural Cambodia

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Abstract:

SETTING: Banteay Meanchey Province, Cambodia.

OBJECTIVE: The World Health Organization recommends human immunodeficiency virus (HIV) testing for all tuberculosis (TB) patients and TB screening for all HIV-infected persons in countries with a TB-HIV syndemic. We sought to determine whether evidence supports implementing these recommendations in South-East Asia.

DESIGN: We conducted a cross-sectional survey and retrospective cohort study of patients newly diagnosed with HIV or TB from October 2003 to February 2005 to identify risk factors for HIV infection and TB, and for death during TB treatment.

RESULTS: HIV infection was diagnosed in 216/574 (38%) TB patients. TB disease was found in 124/450 (24%) HIV-infected persons. No sub-groups of patients had a low risk of HIV infection or TB. Of 180 TB patients with HIV infection and a recorded treatment outcome, 49 (27%) died compared to 17/357 (5%) without HIV infection (relative risk [RR] 5.2, 95% confidence interval [CI] 3.1–8.7). HIV-infected TB patients with smear-negative pulmonary disease died less frequently than those with smear-positive pulmonary disease (RR 0.39, 95%CI 0.16–0.93).

CONCLUSIONS: No sub-groups of patients had low risk for HIV infection or TB, and mortality among HIV-infected TB patients was high. These data justify using the WHO global TB-HIV recommendations in South-East Asia. Urgent interventions are needed to reduce the high mortality rate in HIV-infected TB patients.

Keywords: Cambodia; HIV; epidemiology; mortality; tuberculosis

Document Type: Regular Paper

Affiliations: 1: Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, Atlanta, Georgia, USA; Epidemic Intelligence Service, Office of Workforce and Career Development, Centers for Disease Control and Prevention, Atlanta, Georgia, USA 2: Centers for Disease Control, Global AIDS Program–Cambodia, Phnom Penh, Cambodia 3: Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, Atlanta, Georgia, USA 4: Cambodia Ministry of Health, Banteay Meanchey Provincial Health Department, Provincial AIDS Office, Sisiphon, Cambodia 5: Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, Atlanta, Georgia, USA; Thailand Ministry of Public Health–US CDC Collaboration, Nonthaburi, Thailand

Publication date: September 1, 2007

More about this publication?
  • 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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