A case control study on human immunodeficiency virus-1 (HIV-1) infection as a risk factor for tuberculosis and leprosy in western Kenya.

A case control study was undertaken in Western Kenya from April 1989 to August 1990 to evaluate HIV-1 infection as a risk factor for tuberculosis and leprosy. The study involved 144 newly diagnosed sputum smear positive tuberculosis cases with 432 age, sex and neighbourhood-matched controls, and 132 diagnosed leprosy cases with 384 matched controls. Odds ratios obtained by conditional logistic regression (matched) analysis were 4.9 (95% CI 2.6, 6.8), and 1.8 (95% CI 0.9, 3.2), for the association between HIV-1 and tuberculosis and leprosy respectively. Approximately 31% of tuberculosis cases among males, and 11% of cases among females, were attributable to HIV infection.

PIP: 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).

Case-control study of BCG vaccination as a risk factor for leprosy and tuberculosis in western Kenya.

A case-control study was carried out in western Kenya to measure the protection imparted by BCG against leprosy and tuberculosis. The study involved 69 newly diagnosed leprosy cases, 238 age-, sex- and neighborhood-matched controls, and 144 newly diagnosed, sputum-smear-positive tuberculosis cases along with 432 age-, sex- and neighborhood-matched controls. Information on BCG vaccination history was inferred from scars. Using matched analysis, the protection imparted by BCG against leprosy was estimated to be 81% [95% confidence interval (CI) = 67-90] with no apparent difference in protection against paucibacillary [vaccine efficacy (VE) = 83%, 95% CI = 58-92] and multibacillary leprosy (VE = 76%; 95% CI = 30-91). The effectiveness against tuberculosis was appreciably lower (VE = 22%) and was not statistically significant (95% CI = -20-51).

Multidrug therapy for treatment of paucibacillary leprosy in western Kenya--preliminary communications.

A prospective study is being undertaken in Western Kenya to evaluate the effectiveness and tolerability of WHO-MDT, while at the same time comparing it to a modified multidrug regimen, which is rifampicin 1500mg at the onset supervised, and repeated after 3 months and dapsone 100mg daily for 6 months. Preliminary analysis done on 127 cases admitted into the study are presented. The inactivity index observed between 0-12 weeks was 20% for WHO-MDT and 47% for modified-MDT (p less than 0.01). The inactivity index observed between 0-24 weeks was 63.3% for WHO-MDT and 82.3% for modified-MDT (p less than 0.05). The inactivity index observed between 0-32 weeks was 83% for WHO-MDT, and 88% for modified-MDT. Type 1 reaction was noted in 23.3% on those on WHO-MDT, and 20.3% on those cases on modified-MDT (p greater than 0.1). Compliance rate was 93.8% for those on WHO-MDT and 95.2% on those on modified MDT. All regimens were well tolerated. These preliminary results indicate that MDT is effective in treatment of paucibacillary leprosy, and also that clinical cure can be achieved in much shorter duration, particularly with higher dosage of rifampicin.