Gender and TB/HIV Co-Infection: Presentation and Treatment Outcome in Nigeria

Abstract

TB is the leading single infectious cause of female deaths in the world. Women in their reproductive years have been said to have a higher risk of developing active tuberculosis compared to their male counterpart of the same age. The study aimed to investigate the relationship between gender and the outcome of TB/HIV co-infection among adult patients presenting at the Tuberculosis and Leprosy (TBL) clinic in Sagamu. A retrospective study of 103 HIV positive adults presenting at the TBL clinic of Olabisi Onabanjo University Teaching Hospital, Sagamu between January 1997 and December 2003. Patients were followed up until the completion of the directly observed treatment programme for TB. A favourable outcome was defined as completion of the prescribed treatment for 8 months, while unfavourable outcome were patients who defaulted or died during treatment. Forty-four (42.7%) males and 59(57.3%) females had TB/HIV co-infection. At presentation the mean age was similar but females had a significantly lower body weight compared to males. At the end of 8 months of treatment, 42(71.2%) of females compared with 21(47.7%) of males (OR 2.71, 95% CI 1.11-6.67) had experienced a favourable outcome giving an overall favourable outcome rate of 61.2%. Among the 40 subjects with unfavourable outcome, 22 (55%) had died. There was no significant difference in mortality between male 12(27.3%) and female 10(16.9%). Males had twice the risk of treatment default than females (25% vs 11.9%; p=0.08). Lower body weight at presentation was associated with an unfavourable treatment outcome. Conclusion: Despite differences in presentation, women were more likely than men to adhere to treatment and have a favourable outcome. Men and patients with a lower body mass at presentation need additional support to adhere to treatment so as to have a favourable outcome.

Key words: Gender, TB, HIV, Treatment, Outcome

Nigerian Medical Practitioner Vol.47(4) 2005: 58-60