Browsing by Author "Moshi, Adeline Humphrey"

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    A study of outcome in HIV-seropositive and HIV-seronegative patients with pulmonary tuberculosis admitted to the medical and tuberculosis wards in Muhimbili medical center Dar es Salaam, Tanzania
    (University of Dar es Salaam, 1996) Moshi, Adeline Humphrey
    To assess outcome of treatment in HIV-seropositive and HIVseronegative patients with pulmonary tuberculosis using different measures of outcome. Design: Prospective study of patients suffering from their first episode of pulmonary tuberculosis and followed up for 8 months from start of treatment. Setting:The medical and tuberculosis wards of Muhimbili Medical Centre, Dar es Salaam, Tanzania. Subjects: 230 patients: 85 HIV-seronegative, 75 HIV-seropositive with pulmonary tuberculosis but without features of AIDS and 70 HIVseropositive patients with pulmonary tuberculosis and features of AIDS, admitted between January and mid - April, 1995. Patients received short course chemotherapy. Main outcome measures: Survival rates, quality of life using the SF-36 questionnaire, functional status using Karnofsky scale, weight gain and increase in mid-upper arm circumference at each follow up. Results: After 8 months, 211 patients were analyzed. Thirteen (6. 2 %) patients were lost to follow up and 6 (2.8%) patients defaulted from treatment. Seventy (51.5 %) of all 136 HIV-seropositive patients died within 8 months compared to 9 (12 % ) of the 75 patients with HIV-seronegative pulmonary tuberculosis. Of the 72 HIVseropositive patients without features of AIDS, 25 (34.7 % ) died. Among the 64 HIV-seropositive patients with pulmonary tuberculosis and AIDS, 45 (70.3 %) died within 8 months. The median survival for HIV-seropositive patients with pulmonary tuberculosis and AIDS was 102 days from the start of treatment. Risk factors for death included older age, being HIV-seropositive, having AIDS, severe anaemia, lymphopenia and low Karnofsky score on admission. At 2 months HIV-seronegative patients gained more body weight than HIV-seropositive patients without features of AIDS (p < 0.023) and those with AIDS (p < 0.01). Fourteen (21. 9 % ) HIV-seropositive patients with pulmonary tuberculosis and AIDS were re-admitted compared to HIVseropositive without features of AIDS (p < 0.22) and only one (1.3 % ) of the HIV-seronegative patients (p < 0.001). At the end of 8 months, HIV-seronegative patients had mean scores similar to mean scores for 'normal' Tanzanians in 4 variables of the eight domains of the SF-36 i.e. general health, bodily pain, physical functioning and role emotional. HIV-seropositive patients with pulmonary tuberculosis without features of AIDS had similar scores to those of 'normal' Tanzanians in 3 variables of the SF-36 i.e. bodily pain, vitality and mental health. Patients with pulmonary tuberculosis and AIDS had similar mean scores to those of 'normal' Tanzanians in only one variable of the SF-36 i.e. mental health. At the end of 8 months, 96. 9 % of the HIV-seronegative patients had Karnofsky scores between 80-100. 82.9% of the HIV-seropositive patients without AIDS had similar scores as had 73.7 % of surviving HIV-seropositive patients with AIDS. Conclusion: 1. Mortality is high in HIV-seropositive patients with pulmonary tuberculosis especially those with AIDS. 2. After 8 months of treatment quality of life and functional status in surviving HIV-seronegative patients with pulmonary tuberculosis was comparable to that of 'normal' Tanzanians. Even in patients with AIDS, the quality of life and functional status of survivors made anti- tuberculosis treatment remarkable.