Chronic lung disease in adult recurrent tuberculosis survivors in Zimbabwe: a cohort study

• Published in: The international journal of tuberculosis and lung disease Vol. 23; no. 2; pp. 203 - 211
• Main Authors: Chin, A. T., Rylance, J., Makumbirofa, S., Meffert, S., Vu, T., Clayton, J., Mason, P., Woodruff, P., Metcalfe, J.
• Format: Journal Article
• Language: English
• Published: France International Union Against Tuberculosis and Lung Disease 01.02.2019; International Union against Tuberculosis and Lung Disease (IUATLD)
• Subjects: Abnormalities; Adult; Antitubercular Agents - administration & dosage; Chronic Disease; Chronic Obstructive Pulmonary Disease; Chronic Respiratory Disease; Cohort analysis; Cohort Studies; Female; Follow-Up Studies; Health risk assessment; HIV; HIV Infections - epidemiology; Human immunodeficiency virus; Humans; Lung diseases; Lung Diseases - epidemiology; Lung Diseases - etiology; Male; Mental depression; Mental disorders; Mental health; Middle Aged; Morbidity; Mortality; Obstructive lung disease; Post-Tuberculosis Sequelae; Prevalence; Prospective Studies; Recurrence; Retreatment; Signs and symptoms; Survivors; TB-HIV co-infection; Tuberculosis; Tuberculosis - complications; Tuberculosis - drug therapy; Tuberculosis - epidemiology; Viruses; Zimbabwe; Zimbabwe - epidemiology; Zimbabwe
• ISSN: 1027-3719; 1815-7920
• DOI: 10.5588/ijtld.18.0313

OBJECTIVE: To examine the prevalence and magnitude of chronic lung disease (CLD) and its association with empiric anti-tuberculosis treatment (due to lack of bacteriologic confirmation) among recurrent tuberculosis (TB) survivors in a human immunodeficiency virus (HIV) prevalent setting.METHODS: Prospective cohort study of retreatment TB survivors in Harare, Zimbabwe. At median follow-up of 2 years post-treatment initiation, we characterized mortality, respiratory impairment, and mental health.RESULTS: Among 175 retreatment TB survivors, 65% of whom were HIV-positive and 21% had been empirically treated, multiparameter CLD was noted at follow-up among 14% of patients (95%CI 9.0-19.7), with a six-fold increase in age-adjusted death in the first year following treatment completion. Empirically treated TB (relative risk [RR] 3.4, 95%CI 1.4-8.3) was associated with CLD, as was the number of previous anti-tuberculosis treatment courses in dose-dependent fashion (three vs. one, RR 6.2, 95%CI 1.7-22.1). Among retreatment TB survivors, 33% (95%CI 26.0-40.1) had persistent respiratory symptoms (Chronic Obstructive Pulmonary Disease Assessment Test score 10); 26% (95%CI 19.8-33.0) significant deficits in exercise capacity (median incremental shuttle walk test distance, 550 m; Q1-Q3 440-730 m); 83% (95%CI 75.7-89.7) residual radiographic abnormalities on chest X-ray; 12% (95%CI 6.6-16.1%) moderate-to-severe obstruction on spirometry; and 13% (95%CI 7.6-17.5%) major depression.CONCLUSIONS: Despite successful treatment, retreatment TB survivors retain a substantial risk of morbidity and mortality.