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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Hypoadrenalism is not associated with early mortality during tuberculosis treatment in Malawi
International Journal of Tuberculosis and Lung Disease, Volume 12, No. 3, Year 2008
Notification
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Description
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. © 2008 The Union.
Authors & Co-Authors
Beadsworth, Michael B.J.
Malawi, Zomba
University of Malawi
United Kingdom, Liverpool
Royal Liverpool University Hospital
United Kingdom, Liverpool
Liverpool School of Tropical Medicine
van Oosterhout, Joep J.G.
Malawi, Zomba
University of Malawi
Diver, M.
United Kingdom, Liverpool
University of Liverpool
Faragher, Eric Brian
United Kingdom, Liverpool
Liverpool School of Tropical Medicine
Shenkin, Allan
United Kingdom, Liverpool
University of Liverpool
Mwandumba, Henry Charles
United Kingdom, Liverpool
University of Liverpool
Khoo, Saye Hock
United Kingdom, Liverpool
University of Liverpool
O'Dempsey, Tim J.D.
United Kingdom, Liverpool
Liverpool School of Tropical Medicine
Squire, S. Bertel
United Kingdom, Liverpool
Liverpool School of Tropical Medicine
Zijlstra, Eduard Evert
Malawi, Zomba
University of Malawi
Statistics
Citations: 10
Authors: 10
Affiliations: 4
Identifiers
ISSN:
10273719
Research Areas
Food Security
Infectious Diseases
Study Design
Cross Sectional Study
Cohort Study
Study Locations
Malawi
Participants Gender
Female