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
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Date
1996
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Publisher
University of Dar es Salaam
Abstract
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.
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Keywords
Tuberculosis, Patients, HIV (viruses), Tanzania
Citation
Moshi, A. H. (1996) 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, Masters’ dissertation, University of Dar es Salaam. Available at (http://41.86.178.3/internetserver3.1.2/search.aspx)