HIV testing, HIV status and outcomes of treatment for tuberculosis in a major diagnosis and treatment centre in Yaounde, Cameroon: a retrospective cohort study

BMC Infectious Diseases

André Pascal Kengne¹  Christopher Kuaban³  Eric Walter Pefura Yone² 

[1] South African Medical Research Council & University of Cape Town, Cape Town, South Africa;Yaounde Jamot’s Hospital, P.O Box: 4021, Yaounde, Cameroun;Pneumology service, Yaounde Jamot Hospital, Yaounde, Cameroon

关键词: Outcomes;    HIV infection;    Tuberculosis;   

Others  :  1159718
DOI  :  10.1186/1471-2334-12-190

 received in 2011-11-26, accepted in 2012-06-20,  发布年份 2012

【 摘 要 】

Background

Human immuno-deficiency virus (HIV) infection and tuberculosis are common and often co-occurring conditions in sub-Saharan Africa (SSA). We investigated the effects of HIV testing and HIV status on the outcomes of tuberculosis treatment in a major diagnosis and treatment centre in Yaounde, Cameroon.

Methods

Participants were 1647 adults with tuberculosis registered at the Yaounde Jamot’s Hospital between January and December 2009. Multinomial logistic regression models were used to relate HIV testing and HIV status to the outcomes of tuberculosis treatment during follow-up, with adjustment for potential covariates.

Results

Mean age of participants was 35.5 years (standard deviation: 13.2) and 938 (57%) were men. Clinical forms of tuberculosis were: smear-positive (73.8%), smear-negative (9.4%) and extra-pulmonary (16.8%). Outcomes of tuberculosis treatment were: cure/completion (68.1%), failure (0.4%), default (20.1%), death (5.2%) and transfer (6.3%). Using cure/completion as reference, not testing for HIV was associated with adjusted odds ratio of 2.30 (95% confidence interval: 1.65-3.21), 2.26 (1.29-3.97) and 2.69 (1.62-4.46) for the risk of failure/default, death and transfer respectively. The equivalents for a positive test among those tested (1419 participants) were 1.19 (0.88-1.59), 6.35 (3.53-11.45) and 1.14 (0.69-1.86).

Conclusions

Non-consent for HIV testing in this setting is associated with all unfavourable outcomes of tuberculosis treatment. However been tested positive was the strongest predictor of fatal outcome. Efforts are needed both to improve acceptance of HIV testing among patients with tuberculosis and optimise the care of those tested positive.

【 授权许可】

   
2012 Pefura Yone et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]WHO report. Global tuberculosis control. 2010. http://whqlibdoc.who.int/publications/2010/ webcite
• [2]Mariani F, Goletti D, Ciaramella A, Martino A, Colizzi V, Fraziano M: Macrophage response to Mycobacterium tuberculosis during HIV infection: relationships between macrophage activation and apoptosis. Curr Mol Med 2001, 1:209-216.
• [3]Rosas-Taraco AG, Arce-Mendoza AY, Caballero-Olín G, Salinas-Carmona MC: Mycobacterium tuberculosis upregulates coreceptors CCR5 and CXCR4 while HIV modulates CD14 favoring concurrent infection. AIDS Res Hum Retroviruses 2006, 22:45-51.
• [4]Maartens G, Wilkinson RJ: Tuberculosis. Lancet 2007, 370:2030-2043.
• [5]Kuaban C, Bame R, Mouangue L, Djella S, Yomgni C: Non conversion of sputum smears in new smear positive pulmonary tuberculosis patients in Yaoundé, Cameroon. East Afr Med J 2009, 86:219-225.
• [6]Sume GE, Etogo D, Kabore S, Gnigninanjouena O, Epome SS, Metchendje JN: Seroprevalence of human immunodeficiency virus infection among tuberculosis patients in the Nylon district hospital tuberculosis treatment centre. East Afr Med J 2008, 85:529-536.
• [7]van der Werf MJ, Sebhatu M, Weldegergis T, Tesfazion A, Borgdorff MW: TB-HIV co-infection in Eritrea. Int J Tuberc Lung Dis 2007, 11:823-826.
• [8]Dagnra AY, Adjoh K, Tchaptchet Heunda S, Patassi AA, Sadzo Hetsu D, Awokou F, Tidjani O: Prevalence of HIV-TB co-infection and impact of HIV infection on pulmonary tuberculosis outcome in Togo. Bull Soc Pathol Exot 2010.
• [9]Kuaban C, Bercion R, Koulla-Shiro S: HIV seroprevalence rate and incidence of adverse skin reactions in adults with pulmonary tuberculosis receiving thiacetazone free anti tuberculosis treatment in Yaounde, Cameroon. East Afr Med J 1997, 74:474-477.
• [10]Pefura Yone EW, Kengne AP, Kuaban C: Incidence, time and determinants of tuberculosis treatment default in Yaounde, Cameroon: a retrospective hospital register-based cohort study. BMJ Open 2011, 1:e000289.
• [11]Aït-Khaled N, Alarcón E, Armengol R, Bissell K, Boillot F, Caminero JA, Chiang CY, Clevenbergh P, Dlodlo R, Enarson DA, Enarson P, Fujiwara PI, Harries AD, Heldal E, Hinderaker SG, Monedero I, Rieder HL, Rusen ID, Trébucq A, Van Deun A, Wilson N: Prise en charge de la tuberculose. Guide des éléments essentiels pour une bonne pratique. Paris: Union Internationale Contre la Tuberculose et les Maladies Respiratorires; 2010.
• [12]Programme National de Lutte contre la Tuberculose: Guide Technique pour le personnel de santé. Yaoundé: Ministère de la Santé Publique du Cameroun; 2004.
• [13]Organisation Mondiale de la Santé: Le traitement de la tuberculose: Principes à l’intention des programmes nationaux. Genève: Organisation mondiale de la Santé; 2003.
• [14]Zellweger JP, Coulon P: Outcome of patients treated for tuberculosis in Vaud County, Switzerland. Int J Tuberc Lung Dis 1998, 2:372-377.
• [15]Corbett EL, Marston B, Churchyard GJ, De Cock KM: Tuberculosis in sub-Saharan Africa: opportunities, challenges, and change in the era of antiretroviral treatment. Lancet 2006, 367:926-937.
• [16]Ige OM, Sogaolu OM, Ogunlade OA: Pattern of presentation of tuberculosis and the hospital prevalence of tuberculosis and HIV co-infection in University College Hospital, Ibadan, a review of five years (1998–2002). Afr J Med Sci 2005, 34:329-333.
• [17]Maher D, Harries A, Getahun H: Tuberculosis and HIV interaction in Sub-Saharan Africa: impact on patients and programmes, implications for policies. Trop Med Int Health 2005, 10:734-742.
• [18]Nkoghe D, Toung Mve M, Nnegue S, Okome Nkoume M, Iba BJ, Hypolite J, Leonard P, Kendjo E: Séroprévalence du VIH au sein des tuberculeux de l’hôpital de Nkembo à Libreville, Gabon. Bull Soc Pathol Exot 2005, 98:121-122.
• [19]Ollé-Goig JE: Tuberculosis in rural Uganda. Afr Health Sci 2010, 10:226-229.
• [20]Habib AG: A clinical and epidemiologic update on the interaction between tuberculosis and human immunodeficiency virus infection in adults. Ann Afr Med 2009, 8:147-155.
• [21]Cain KP, Kanara N, Laserson KF, Vannarith C, Sameourn K, Samnang K, Qualls ML, Wells CD, Varma JK: The epidemiology of HIV-associated tuberculosis in rural Cambodia. Int J Tuberc Lung Dis 2007, 11:1008-1013.
• [22]Pontororing GJ, Kenangalem E, Lolong DB, Waramori G, Sandjaja , Tjitra E, Price RN, Kelly PM, Anstey NM, Ralph AP: The burden and treatment of HIV in tuberculosis patients in Papua Province, Indonesia: a prospective observational study. BMC Infect Dis 2010, 10:362. BioMed Central Full Text
• [23]AIDS epidemic update. UNAIDS/WHO; 2008. http://data.unaids.org/pub/Report/2008/jc1535_annual_report07_fr.pdf webcite
• [24]Ministry of Public Health: Report on HIV sentinel surveillance system in Cameroon. Yaounde: Ministry of Public Health of Cameroon; 1994.
• [25]Sharma SK, Mohan A: Extrapulmonary tuberculosis. Indian J Med Res 2004, 120:316-353.
• [26]Golden MP, Vikram HR: Extrapulmonary tuberculosis: an overview. Am Fam Physician 2005, 72:1761-1768.
• [27]Aderaye G, Bruchfeld J, Assefa G, Feleke D, Källenius G, Baat M, Lindquist L: The relationship between disease pattern and disease burden by chest radiography, M. tuberculosis Load, and HIV status in patients with pulmonary tuberculosis in Addis Ababa. Infection 2004, 32:333-338.
• [28]Mugusi F, Villamor E, Urassa W, Saathoff E, Bosch RJ, Fawzi WW: HIV coinfection CD4 cell counts and clinical correlates of bacillary density in pulmonary tuberculosis. Int J Tuberc Lung Dis 2006, 10:663-669.