Hypoadrenalism is not associated with early mortality during tuberculosis treatment in Malawi

Beadsworth, M., van Oosterhout, J. J., Diver, M. J., Faragher, Brian, Shenkin, A., Mwandumba, Henry ORCID: https://orcid.org/0000-0003-4470-3608, Khoo, S., O'Dempsey, Timothy ORCID: https://orcid.org/0000-0002-9596-9687, Squire, Bertie ORCID: https://orcid.org/0000-0001-7173-9038 and Zijlstra, E. E. (2008) 'Hypoadrenalism is not associated with early mortality during tuberculosis treatment in Malawi'. International Journal of Tuberculosis and Lung Disease, Vol 12, Issue 3, pp. 314-318.

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Abstract

SETTING: In the developing world, early mortality within 1 month of commencing tuberculosis (TB) treatment is high, particularly with human immunodeficiency virus (HIV) co-infection. In Malawi, 40% of those who die do so in the first month of treatment. Reasons remain unclear and may include delayed diagnosis, opportunistic infections, immune restoration inflammatory syndrome (IRIS) or malnutrition. One possible contributing factor is underlying hypoadrenalism associated with TB-HIV, exacerbated by rifampicin (RMP) induction of P450 and glucocorticoid metabolism. OBJECTIVE: To assess the prevalence of hypoadrenalism in TB patients before and after commencement of TB treatment, and relationship with early mortality. DESIGN: Prospective descriptive study assessing hypoadrenalism before and after anti-tuberculosis treatment, HIV status and outcome up to 3 months post-treatment. RESULTS: Of 51 patients enrolled, 29 (56.9%) were female (median age 32 years, range 18-62). Of 43 patients HIV-tested, 38 (88.3%) were HIV-positive and 15.7% died within the first month. At 3 months, 11 (21.6%) were known to have died. Adequate cortisol levels were found in 49/51 (95.9%) before commencing RMP. Neither of the two with reduced response died. All 34 patients revealed adequate cortisol responses at 2 weeks. CONCLUSION: No evidence of hypoadrenalism was found in this first study to assess adrenal function and outcome of anti-tuberculosis treatment.

Item Type:	Article
Uncontrolled Keywords:	hypoadrenalism tuberculosis hiv malawi sub-saharan africa human-immunodeficiency-virus adrenal tuberculosis early death insufficiency disease axis
Subjects:	WK Endocrine System > WK 100 Endocrine glands (General) WF Respiratory System > Tuberculosis > WF 200 Tuberculosis (General) WC Communicable Diseases > Virus Diseases > Acquired Immunodeficiency Syndrome. HIV Infections > WC 503 Acquired immunodeficiency syndrome. HIV infections WF Respiratory System > Tuberculosis > WF 220 Diagnosis. Prognosis
Faculty: Department:	Groups (2002 - 2012) > Clinical Group
Depositing User:	Helen Rigby
Date Deposited:	28 Jun 2010 14:32
Last Modified:	13 Nov 2019 11:20
URI:	https://archive.lstmed.ac.uk/id/eprint/731

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