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Gender and HIV-associated pulmonary tuberculosis: presentation and outcome at one year after beginning antituberculosis treatment in Uganda

DOI: 10.1186/1471-2466-2-4

Keywords: Tuberculosis, Gender, HIV infection

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Abstract:

We enrolled and followed up a cohort of 105 male and 109 female HIV-infected adults on treatment for initial episodes of culture-confirmed pulmonary tuberculosis between March 1993 and March 1995. A favorable outcome was defined as being cured and alive at one year while an unfavorable outcome was not being cured or dead. Subjects were followed-up by serial medical examinations, complete blood counts, serum β2 microglobulin, CD4+ cell counts, sputum examinations, and chest x-rays.Male patients were older, had higher body mass indices, and lower serum β2 microglobulin levels than female patients at presentation. At one year, there was no difference between male and female patients in the likelihood of experiencing a favorable outcome (RR 1.02, 95% CI 0.89–1.17). This effect persisted after controlling for symptoms, serum β2 microglobulin, CD4+ cell count, and severity of disease on chest x-ray (OR 1.07, 95% CI 0.54–2.13) with a repeated measures model.While differences existed between males and females with HIV-associated pulmonary tuberculosis at presentation, the outcomes at one year after the initiation of tuberculosis treatment were similar in Uganda. Women in areas with a high HIV and tuberculosis prevalence should be encouraged to present for screening at the first sign of tuberculosis symptoms.Tuberculosis is estimated to cause at least three million deaths per year worldwide [1] and also accounts for more than one-quarter of all preventable adult deaths in developing countries [2]. Infection with the human immuno-deficiency virus (HIV) is thought to be the single most important factor that has contributed to the increased incidence of tuberculosis globally in the last decade [2]. Tuberculosis is now the leading cause of death among HIV-infected individuals worldwide and accounts for at least 40% of deaths among HIV-infected persons in Africa [3]. Furthermore, tuberculosis kills more women than any other infectious disease, including malaria and AIDS [4].Repor

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