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Free Content Synergism between diabetes and human immunodeficiency virus in increasing the risk of tuberculosis

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SETTING: Community health screenings in KwaZulu-Natal Province, South Africa.

OBJECTIVE: To study the synergism between diabetes mellitus (DM) and human immunodeficiency virus (HIV) infection in increasing the risk of tuberculosis (TB).

DESIGN: In this cross-sectional study, we analyzed data from two community health projects, one at congregate settings, and one at household settings (n = 7708), in a rural resource-limited region where integrated communicable and non-communicable disease screening services were offered. Odds ratios (ORs) for demographic factors, socio-economic factors, DM status, and HIV positivity were calculated using multivariate analysis, and the statistical interaction between HIV and DM was tested. The primary outcome was the presence of TB symptoms.

RESULTS: Among 7708 individuals, age >65 years (OR 1.72, 95%CI 1.47–2.02), HIV infection (OR 1.66, 95%CI 1.40–1.97) and DM (OR 1.36, 95%CI 1.11–1.67) were independently associated with increased odds of TB symptoms. Receiving monthly grants (OR 0.78, 95%CI 0.66–0.91), access to a toilet (OR 0.54, 95%CI 0.35–0.83), and access to solar or electric energy (OR 0.86, 95%CI 0.77–0.97) reduced the odds. There was evidence of significant interaction between DM and HIV on the multiplicative scale.

CONCLUSION: DM and HIV synergistically increased the odds of TB symptoms according to these retrospective data. Future studies should prospectively evaluate synergism between HIV and DM in increasing the risk of active TB.
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Keywords: community-based; diabetes; interaction; screening; tuberculosis

Document Type: Research Article

Affiliations: 1: Department of Internal Medicine, Section of Infectious Diseases, AIDS Program, Yale University School of Medicine, New Haven, Connecticut, USA 2: Church of Scotland Hospital, ARV Programme, Tugela Ferry, South Africa 3: Yale Center for Analytical Sciences, Yale School of Public Health, New Haven, Connecticut, USA

Publication date: July 1, 2018

More about this publication?
  • 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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