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© 1993 Oxford University Press

other

HIV-1 Infection as a Risk Factor for the Development of Tuberculosis: A Case-Control Study in Tanzania

J VAN DEN BROEK*, M W BORGDORFF**,{dagger}, N G PAKKER{ddagger}, H J CHUM*, A H KLOKKE§, K P SENKORO** and J N NEWELL|,¶

* National Tuberculosis/Leprosy Programme PO Box 9083, Dar es Salaam, Tanzania
** National Institute for Medical Research PO Box 1462, Mwanza, Tanzania
{dagger} Royal Tropical Institute Mauritskade 63, 1092 AD Amsterdam, The Netherlands
{ddagger} Nijmegen Institute for International Health PO Box 9101, Nijmegen, The Netherlands
§ Bugando Medical Centre PO Box 1370, Mwanza, Tanzania
| African Medical and Research Foundation PO Box 1482, Mwanza, Tanzania
London School of Hygiene and Tropical Medicine Keppel Street, London WCIE 7HT, UK

A population-based case-control study was carried out in Mwanza Region, Tanzania, to determine the relative and population attributable risk of human immunodeficiency virus type 1 (HIV-1) infection for developing active tuberculosis. Cases were 441 consecutively diagnosed patients with tuberculosis (all types), aged 15–54 years. Controls were a representative population sample of 4161 people, drawn in a stratified cluster sample from urban areas, roadside settlements, and rural villages. HIV-1 infection was determined by ELISA and if the ELISA result was indeterminate by Western Blot. The HIV-1 prevalence in cases was 23.0% in rural, 32.1% in roadside, and 54.1% in urban areas, while in controls these prevalences were 3.4%, 7.2% and 12.1% respectively. The relative risk (RR) of HIV-1 infection for the development of active tuberculosis was estimated to be 8.3 (95% confidence interval [Cl] 6.4–11.0). This risk varied little by sex or residence, but appeared to be more pronounced in the age group 25–34 years. The case detection rate of tuberculosis in those aged 15–54 years was 125/100 000 people per year. The population attributable risk was 36/100 000 people per year, implying that 29% of tuberculosis cases at present may be attributable to HIV-1 infection. It is concluded that HIV-1 infection is a major contributing factor to the increased case detection rate of tuberculosis observed over the past 10 years in Mwanza Region. If the prevalence of HIV-1 continues to increase, the incidence of tuberculosis will continue to rise as well. Maintaining a high cure rate of tuberculosis patients will be imperative to prevent an increased risk of tuberculosis infection to HIV-1 infected and uninfected people.

Received 1 March 1993


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