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Free Content Hypoadrenalism is not associated with early mortality during tuberculosis treatment in Malawi

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SETTING: In the developing world, early mortality within 1 month of commencing tuberculosis (TB) treatment is high, particularly with human immunodeficiency virus (HIV) co-infection. In Malawi, 40% of those who die do so in the first month of treatment. Reasons remain unclear and may include delayed diagnosis, opportunistic infections, immune restoration inflammatory syndrome (IRIS) or malnutrition. One possible contributing factor is underlying hypoadrenalism associated with TB-HIV, exacerbated by rifampicin (RMP) induction of P450 and glucocorticoid metabolism.

OBJECTIVE: To assess the prevalence of hypoadrenalism in TB patients before and after commencement of TB treatment, and relationship with early mortality.

DESIGN: Prospective descriptive study assessing hypoadrenalism before and after anti-tuberculosis treatment, HIV status and outcome up to 3 months post-treatment.

RESULTS: Of 51 patients enrolled, 29 (56.9%) were female (median age 32 years, range 18–62). Of 43 patients HIV-tested, 38 (88.3%) were HIV-positive and 15.7% died within the first month. At 3 months, 11 (21.6%) were known to have died. Adequate cortisol levels were found in 49/51 (95.9%) before commencing RMP. Neither of the two with reduced response died. All 34 patients revealed adequate cortisol responses at 2 weeks.

CONCLUSION: No evidence of hypoadrenalism was found in this first study to assess adrenal function and outcome of anti-tuberculosis treatment.

Keywords: HIV; Malawi; hypoadrenalism; sub-Saharan Africa; tuberculosis

Document Type: Regular Paper

Affiliations: 1: Department of Medicine, College of Medicine, University of Malawi, Blantyre, Malawi; Tropical and Infectious Diseases Unit, Royal Liverpool University Hospital, Liverpool, UK; Liverpool School of Tropical Medicine, Liverpool, UK 2: Department of Medicine, College of Medicine, University of Malawi, Blantyre, Malawi 3: Department of Clinical Chemistry, University of Liverpool, Liverpool, UK 4: Liverpool School of Tropical Medicine, Liverpool, UK 5: Department of Pharmacology & Therapeutics, University of Liverpool, Liverpool, UK

Publication date: 2008-03-01

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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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