Recent transmission of tuberculosis in a cohort of HIV-1-infected female sex workers in Nairobi, Kenya : AIDS

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Recent transmission of tuberculosis in a cohort of HIV-1-infected female sex workers in Nairobi, Kenya

Gilks, Charles F.1,5,8,9; Godfrey-Faussett, Peter2,6; Batchelor, Barry I.F.3; Ojoo, Josephine C.1; Ojoo, Sylvia J.1; Brindle, Richard J.3; Paul, John3; Kimari, Joseph3; Bruce, Marian C.2; Bwayo, Joab4; Plummer, Francis A.4,7; Warrell, David A.5

Author Information

1Clinical Research Centre, Kenya Medical Research Institute, Nairobi, Kenya

2Departments of Medicine, and Pathology and Microbiology, University Teaching Hospital, Lusaka, Zambia

3Centre for Microbiology Research, Kenya Medical Research Institute

4Department of Medical Microbiology, University of Nairobi, Nairobi, Kenya

5Centre for Tropical Medicine, University of Oxford, Oxford

6Department of Clinical Science, London School of Hygiene and Tropical Medicine, London, UK

7University of Winnipeg, Winnipeg, Manitoba, Canada.

8Present address: Liverpool School of Tropical Medicine, Liverpool, UK.

9Requests for reprints to: Dr Charles Gilks, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK.

Sponsorship: The study was funded by the Wellcome Trust with support from the Science and Technology for Developing Countries, programme III, of the Commission of the European Community; P.G-F. was in receipt of an MRC training fellowship.

Date of receipt: 7 November 1996; revised: 20 February 1997; accepted: 28 February 1997.

AIDS 11(7):p 911-918, June 11, 1997.

Abstract

Objectives: 

To describe the epidemiological and clinical characteristics of HIV-related tuberculosis in a female cohort, and to investigate the relative importance of recently transmitted infection and reactivation in the pathogenesis of adult HIV-related tuberculosis.

Design: 

Members of an established cohort of female sex workers in Nairobi were enrolled in a prospective study. Women were followed up regularly and seen on demand when sick.

Methods: 

Between October 1989 and September 1992 we followed 587 HIV-infected and 132 HIV-seronegative women. Standard protocols were used to investigate common presentations. Cases of tuberculosis were identified clinically or by culture. All available Mycobacterium tuberculosis strains underwent DNA fingerprint analysis.

Results: 

Forty-nine incident and four recurrent episodes of tuberculosis were seen in HIV-infected women; no disease was seen in seronegative sex workers (P = 0.0003). The overall incidence rate of tuberculosis was 34.5 per 1000 person-years amongst HIV-infected participants. In purified protein derivative (PPD) skin test-positive women the rate was 66.7 per 1000 person-years versus 18.1 per 1000 person-years in PPD-negative women. Twenty incident cases (41%) were clinically compatible with primary disease. DNA fingerprint analysis of strains from 32 incident cases identified two clusters comprising two and nine patients; allowing for index cases, 10 patients (28%) may have had recently transmitted disease. Three out of 10 (30%) patients who were initially PPD skin test-negative became PPD-positive. Taken together, 26 incident cases (53%) may have been recently infected. DNA fingerprint analysis also identified two (50%) of the four recurrent tuberculosis episodes as reinfection.

Conclusions: 

Substantial recent transmission of tuberculosis appears to be occurring in Nairobi amongst HIV-infected sex workers. It may be incorrect to assume in other regions of high tuberculosis transmission that active HIV-related tuberculosis usually represents reactivation of latent infection.

© Lippincott-Raven Publishers.

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