A case control study on human immunodeficiency virus-1 (HIV-1) infection as a risk factor for tuberculosis and leprosy in western Kenya
Orege, P.A.; Fine, P.E.; Lucas, S.B.; Obura, M.; Okelo, C.; Okuku, P.; Were, M.
Tubercle and Lung Disease the Official Journal of the International Union Against Tuberculosis and Lung Disease 74(6): 377-381
ISSN/ISBN: 0962-8479 PMID: 8136490 DOI: 10.1016/0962-8479(93)90080-h
Between April, 1989, and August 1990. in Busia, Siaya, Kisumu, and South Nyanza districts of Western Kenya, health workers recruited 144 sputum smear positive tuberculosis (TB) cases and 432 age, sex, and neighborhood matched controls. They also recruited 132 newly detected leprosy cases and 384 matched controls. Researchers wanted to determine the association between HIV-1 and TB and between HIV-1 and leprosy. TB cases were more likely to be HIV-1 seropositive than were their controls, regardless of age (odds ratio = 4.9). Less than 30-year-old female TB patients were less likely to be HIV-1 seropositive than were less than 30-year-old male TB patients (OR, 2.8 vs. 8.1), while the opposite was true for older TB patients (OR, 19.6 vs. 2.6). Though not statistically different, the OR was greater for certain TB cases than for possible TB cases (13.7 vs. 3.5) and for BCG negative cases than for BCG positive cases (16.5 vs. 3.1). Etiologic fractions indicated that HIV infection was responsible for 31% of TB cases among males and 11% of TB cases among females. Overall, leprosy cases and controls had lower HIV seropositivity rates than did their TB counterparts (OR, 1.8 vs. 4.9). Even though none of the ORs for the association between HIV infection and leprosy were statistically significant from unity, the fact that ORs were greater than unity in all (1.4-2.4) but 1 group (5-29 year old females, OR = 0.5) indicated a possible trend towards positive association. Though not statistically different, polar lepromatous type of leprosy and the leprosy category of histopathologically confirmed cases had the highest ORs (3.7 and 1.9, respectively). Multibacillary leprosy cases had a higher OR than did paucibacillary leprosy (2 vs. 1.6).