• Trop. Med. Int. Health · Sep 2016

    Tuberculosis and non-tuberculous mycobacteria among HIV-infected individuals in Ghana.

    • Stephanie Bjerrum, Joseph Oliver-Commey, Ernest Kenu, Margaret Lartey, Mercy Jemima Newman, Kennedy Kwasi Addo, Doris Hilleman, Aase Bengaard Andersen, and Isik Somuncu Johansen.
    • Department of Infectious Diseases, Odense University Hospital, Odense, Denmark.
    • Trop. Med. Int. Health. 2016 Sep 1; 21 (9): 1181-90.

    ObjectivesTo assess the prevalence and clinical importance of previously unrecognised tuberculosis (TB) and isolation of non-tuberculous mycobacteria (NTM) among HIV-infected individuals in a teaching hospital in Ghana.MethodsIntensified mycobacterial case finding was conducted among HIV-positive individuals before initiation of antiretroviral therapy (ART). Data were collected on socio-demographic characteristics, medical history and TB-related signs and symptoms, and participants were followed for six months to determine treatment and vital status. Two sputum samples were obtained and examined for mycobacteria with smear microscopy, culture and Xpert MTB/RIF assay. NTM species were identified with the GenoType Mycobacterium CM/AS or sequence analysis of 16S rRNA gene.ResultsOf 473 participants, 60 (12.7%) had confirmed pulmonary TB, and 38 (8.0%) had positive cultures for NTM. Mycobacterium avium complex was identified in 9/38 (23.7%) of NTM isolates. Participants with NTM isolated were more likely to have CD4 cell count< 100 cells/μL (aOR 2.37; 95% CI: 1.10-5.14), BMI<18.5kg/m(2) (aOR 2.51; 95% CI: 1.15-5.51) and fever ≥2 weeks (aOR 2.76; 95% CI: 1.27-6.03) at baseline than participants with no mycobacteria. By six months, 76 (16.1%) participants had died; 20 (33.3%) with confirmed TB and 9 (23.7%) with NTM-positive culture. Mortality at six months was independently associated with TB diagnosis at enrolment (aHR 1.97; 95% CI 1.09-3.59), but not with NTM isolation after controlling for age, sex, CD4 cell count, BMI, prolonged fever and ART initiation.ConclusionsIntensified mycobacterial screening of HIV-infected individuals revealed a high burden of unrecognised pulmonary TB before ART initiation, which increased risk of death within six months. NTM were frequently isolated and associated with signs of poor clinical status but not with increased mortality.© 2016 The Authors. Tropical Medicine & International Health Published by John Wiley & Sons Ltd.

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