Chronic lung disease in adult recurrent tuberculosis survivors in Zimbabwe: a cohort study
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: Pro...
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Published in | The international journal of tuberculosis and lung disease Vol. 23; no. 2; pp. 203 - 211 |
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Main Authors | , , , , , , , , |
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 | |
Online Access | Get full text |
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Summary: | 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. |
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Bibliography: | 1027-3719(20190201)23:2L.203;1- (R) Medicine - General ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 |
ISSN: | 1027-3719 1815-7920 |
DOI: | 10.5588/ijtld.18.0313 |