Title | Chronic lung disease in adult recurrent tuberculosis survivors in Zimbabwe: a cohort study. |
Publication Type | Publication |
Year | 2019 |
Authors | Chin AT, Rylance J, Makumbirofa S, Meffert S, Vu T, Clayton J, Mason P, Woodruff P, Metcalfe J |
Journal | Int J Tuberc Lung Dis |
Volume | 23 |
Issue | 2 |
Pagination | 203-211 |
Date Published | 2019 Feb 01 |
ISSN | 1815-7920 |
Keywords | Adult, Antitubercular Agents, Chronic Disease, Cohort Studies, Female, Follow-Up Studies, HIV Infections, Humans, Lung Diseases, Male, Middle Aged, Prevalence, Prospective Studies, Recurrence, Retreatment, Survivors, Tuberculosis, Zimbabwe |
Abstract | 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; Q-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. |
DOI | 10.5588/ijtld.18.0313 |
Alternate Journal | Int J Tuberc Lung Dis |
PubMed ID | 30808453 |
PubMed Central ID | PMC6860915 |
Grant List | D43 TW009539 / TW / FIC NIH HHS / United States K23 AI094251 / AI / NIAID NIH HHS / United States |
Chronic lung disease in adult recurrent tuberculosis survivors in Zimbabwe: a cohort study.
MS#:
MS113
Manuscript Full Title:
Chronic lung disease in adult recurrent tuberculosis survivors in Zimbabwe: a cohort study.
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Manuscript Status:
Published and Public