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Chronic lung disease in adult recurrent tuberculosis survivors in Zimbabwe: a cohort study.

Chin, A T, Rylance, Jamie ORCID: https://orcid.org/0000-0002-2323-3611, Makumbirofa, S, Meffert, S, Vu, T, Clayton, J, Mason, P, Woodruff, P and Metcalfe, J (2019) 'Chronic lung disease in adult recurrent tuberculosis survivors in Zimbabwe: a cohort study.'. International Journal of Tuberculosis and Lung Disease, Vol 23, Issue 2, pp. 203-211.

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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.

Item Type: Article
Subjects: WA Public Health > WA 30 Socioeconomic factors in public health (General)
WA Public Health > Health Problems of Special Population Groups > WA 395 Health in developing countries
WF Respiratory System > Tuberculosis > WF 200 Tuberculosis (General)
WF Respiratory System > Lungs > WF 600 Lungs
Faculty: Department: Clinical Sciences & International Health > Clinical Sciences Department
Digital Object Identifer (DOI): https://doi.org/10.5588/ijtld.18.0313
Depositing User: Stacy Murtagh
Date Deposited: 04 Mar 2019 16:12
Last Modified: 23 Aug 2019 13:17
URI: https://archive.lstmed.ac.uk/id/eprint/10307

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