Lead author Alison D. Grant, M.B.B.S., Ph.D., of the London School of Hygiene and Tropical Medicine, London, presented the findings of the study at a JAMA media briefing on tuberculosis at the National Press Club.

A major consequence of the human immunodeficiency virus (HIV) epidemic in developing countries is the increasing incidence of tuberculosis (TB), according to background information in the article. The cornerstone of TB control programs is the World Health Organization (WHO) strategy known as DOTS (directly observed therapy, short course), which may be effective in controlling drug resistance but has not prevented rising TB incidence in regions with high HIV prevalence.

The impact of HIV on TB is illustrated by data from gold mines in South Africa, where overall TB incidence now exceeds 4,000 per 100,000 population per year (i.e., 4 percent). Tuberculosis incidence was already high in this setting before the spread of HIV infection, largely because of a high prevalence of silica dust exposure. Rising HIV prevalence has resulted in increasing TB incidence, despite well-implemented TB control programs. Additional interventions are required to reverse the rise of TB in such settings.

In collaboration with the mining health service, the study team established a clinic for HIV-infected employees in a gold mining company in South Africa in 1999 to provide specialist care for HIV-infected employees, including preventive therapy (isoniazid and cotrimoxazole). This study evaluates the effect of this intervention. The authors analyzed 1,655 HIV-infected males (median age, 37 years) attending the clinic between 1999 and 2001 (before antiretroviral therapy was available). Median follow-up was 22.1 months. Employees were invite
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Contact: Alison D. Grant, M.B.B.S., Ph.D.
alison.grant@lshtm.ac.uk
JAMA and Archives Journals
7-Jun-2005