Published ahead of print on June 10, 2004, doi:10.1164/rccm.200405-590OC
Am. J. Respir. Crit. Care Med., Volume 170, Number 6, September 2004, 673-679
A more recent version of this article appeared on September 15, 2004
Submitted on May 7, 2004
Accepted on June 9, 2004
Human Immunodeficiency Virus and the Prevalence of Undiagnosed Tuberculosis in African Gold Miners
Elizabeth L Corbett1*, Salome Charalambous2, Vicky M Moloi2, Katherine Fielding3, Alison D Grant3, Christopher Dye4, Kevin M De Cock3, Richard J Hayes3, Brian G Williams4, and Gavin J Churchyard5
1 Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom; Biomedical Research and Training Institute, Harare, Zimbabwe,
2 Aurum Health Research, Westvaal Hospital, Orkney, South Africa,
3 Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom,
4 Communicable Diseases Cluster, World Health Organization, Geneva, Switzerland,
5 Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom; Aurum Health Research, Westvaal Hospital, Orkney, South Africa
* To whom correspondence should be addressed. E-mail: elc1{at}mweb.co.zw..
We hypothesised that rapid presentation may be a general feature of tuberculosis associated with Human Immunodeficiency Virus (HIV) that limits the impact of HIV on the point prevalence of tuberculosis. To investigate this we carried out a cross-sectional HIV and tuberculosis disease survey with retrospective and prospective follow-up. HIV prevalence among 1773 systematically recruited miners was 27%. Tuberculosis incidence was much more strongly HIV-associated (incidence rate ratio 5.5; 95% CI 3.5 - 8.6) than the point prevalence of undiagnosed tuberculosis disease (odds ratio 1.7, 95% CI 0.9 - 3.3). For smear-positive tuberculosis, 7 (78%) of 9 prevalent cases were HIV-negative, and point prevalence was non-significantly lower in HIV-positive miners (OR 0.8; 95% CI 0.1 - 4.2). Calculated mean duration of smear-positivity before diagnosis (point prevalence / incidence) was substantially shorter for HIV-positive than HIV-negative tuberculosis patients (0.17 and 1.15 years respectively; ratio 0.15: 95% CI 0.00 - 0.73). HIV has considerably less impact on the point prevalence of tuberculosis disease than on tuberculosis incidence, probably because rapid disease progression increases presentation and case-finding rates. The difference in mean duration of smear-positivity was particularly marked and, if generalisable, will have major implications for tuberculosis control prospects in high HIV prevalence areas.
Key words: HIV, Africa, Tuberculosis, Prevalence, Epidemiology
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