Recent transmission of tuberculosis in a cohort of HIV-1-infected female sex workers in Nairobi, Kenya.
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Date
1997Author
Gilks, CF
Godfrey-Faussett, P
Batchelor, BI
Ojoo, JC
Ojoo, SJ
Brindle, RJ
Paul, J
Kimari, J
Bruce, MC
Bwayo, J
Plummer, FA
Warrell, DA
Type
ArticleLanguage
enMetadata
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Abstract
OBJECTIVES:
To describe the epidemiological and clinical characteristics of HIV-related tuberculosis in a female cohort, and to investigate the relative importance of recently transmitted infection and reactivation in the pathogenesis of adult HIV-related tuberculosis.
DESIGN:
Members of an established cohort of female sex workers in Nairobi were enrolled in a prospective study. Women were followed up regularly and seen on demand when sick.
METHODS:
Between October 1989 and September 1992 we followed 587 HIV-infected and 132 HIV-seronegative women. Standard protocols were used to investigate common presentations. Cases of tuberculosis were identified clinically or by culture. All available Mycobacterium tuberculosis strains underwent DNA fingerprint analysis.
RESULTS:
Forty-nine incident and four recurrent episodes of tuberculosis were seen in HIV-infected women; no disease was seen in seronegative sex workers (P = 0.0003). The overall incidence rate of tuberculosis was 34.5 per 1000 person-years amongst HIV-infected participants. In purified protein derivative (PPD) skin test-positive women the rate was 66.7 per 1000 person-years versus 18.1 per 1000 person-years in PPD-negative women. Twenty incident cases (41%) were clinically compatible with primary disease. DNA fingerprint analysis of strains from 32 incident cases identified two clusters comprising two and nine patients; allowing for index cases, 10 patients (28%) may have had recently transmitted disease. Three out of 10 (30%) patients who were initially PPD skin test-negative became PPD-positive. Taken together, 26 incident cases (53%) may have been recently infected. DNA fingerprint analysis also identified two (50%) of the four recurrent tuberculosis episodes as reinfection.
CONCLUSIONS:
Substantial recent transmission of tuberculosis appears to be occurring in Nairobi amongst HIV-infected sex workers. It may be incorrect to assume in other regions of high tuberculosis transmission that active HIV-related tuberculosis usually represents reactivation of latent infection.
URI
http://erepository.uonbi.ac.ke:8080/xmlui/handle/123456789/57694http://www.ncbi.nlm.nih.gov/pubmed/9189217
Publisher
University of Nairobi c
Description
Journal Article
Collections
- Faculty of Health Sciences (FHS) [10377]