A T Chin1, J Rylance2, S Makumbirofa3, S Meffert4, T Vu5, J Clayton6, P Mason3, P Woodruff6, J Metcalfe6. 1. School of Medicine, University of California, San Francisco, California, USA. 2. Liverpool School of Tropical Medicine, Liverpool, UK. 3. Biomedical Research & Training Institute, Harare, Zimbabwe. 4. Department of Psychiatry. 5. Department of Radiology. 6. Division of Pulmonary and Critical Care Medicine, University of California, San Francisco, California, USA.
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; 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.
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.
Authors: David Couper; Lisa M LaVange; MeiLan Han; R Graham Barr; Eugene Bleecker; Eric A Hoffman; Richard Kanner; Eric Kleerup; Fernando J Martinez; Prescott G Woodruff; Stephen Rennard Journal: Thorax Date: 2013-09-12 Impact factor: 9.139
Authors: Vanessa S Probst; Nidia A Hernandes; Denilson C Teixeira; Josiane M Felcar; Rafael B Mesquita; Cristiane G Gonçalves; Daniela Hayashi; Sally Singh; Fabio Pitta Journal: Respir Med Date: 2011-08-23 Impact factor: 3.415
Authors: A M B Menezes; P C Hallal; R Perez-Padilla; J R B Jardim; A Muiño; M V Lopez; G Valdivia; M Montes de Oca; C Talamo; J Pertuze; C G Victora Journal: Eur Respir J Date: 2007-09-05 Impact factor: 16.671
Authors: Anna P Ralph; Enny Kenangalem; Govert Waramori; Gysje J Pontororing; Emiliana Tjitra; Graeme P Maguire; Paul M Kelly; Nicholas M Anstey Journal: PLoS One Date: 2013-11-29 Impact factor: 3.240
Authors: Denise Rossato Silva; Alana Ambos Freitas; Amanda Reis Guimarães; Lia D'Ambrosio; Rosella Centis; Marcela Muñoz-Torrico; Dina Visca; Giovanni Battista Migliori Journal: J Bras Pneumol Date: 2022-05-13 Impact factor: 2.800
Authors: Jamilah Meghji; Maia Lesosky; Elizabeth Joekes; Peter Banda; Jamie Rylance; Stephen Gordon; Joseph Jacob; Harmien Zonderland; Peter MacPherson; Elizabeth L Corbett; Kevin Mortimer; Stephen Bertel Squire Journal: Thorax Date: 2020-02-26 Impact factor: 9.139
Authors: Sara H Browne; Mike Bernstein; Samuel C Pan; Jonathan Gonzalez Garcia; Craig A Easson; Chung-Che Huang; Florin Vaida Journal: Chest Date: 2020-09-11 Impact factor: 9.410
Authors: Sara C Auld; Hardy Kornfeld; Pholo Maenetje; Mandla Mlotshwa; William Chase; Mboyo di-Tamba Vangu; Drew A Torigian; Robert S Wallis; Gavin Churchyard; Gregory P Bisson Journal: BMC Pulm Med Date: 2021-01-07 Impact factor: 3.320