Hypoadrenalism is not associated with early mortality during tuberculosis treatment in Malawi

• Published in: The international journal of tuberculosis and lung disease Vol. 12; no. 3; pp. 314 - 318
• Main Authors: BEADSWORTH, M. B. J, VAN OOSTERHOUT, J. J, DIVER, M. J, FARAGHER, E. B, SHENKIN, A, MWANDUMBA, H. C, KHOO, S, O'DEMPSEY, T, SQUIRE, S. B, ZIJISTRA, E. E
• Format: Journal Article
• Language: English
• Published: Paris, France IUATLD 01-03-2008; Union internationale contre la tuberculose et les maladies respiratoires
• Subjects: Adolescent; Adrenal Insufficiency - blood; Adrenal Insufficiency - epidemiology; Adrenals. Adrenal axis. Renin-angiotensin system (diseases); Adult; Antibiotics, Antitubercular - adverse effects; Antibiotics, Antitubercular - therapeutic use; Biological and medical sciences; Comorbidity; Endocrinopathies; Female; HIV; HIV Infections - epidemiology; Human immunodeficiency virus; Human immunodeficiency virus 1; Humans; Hydrocortisone - blood; Hypoadrenalism; Malawi; Malawi - epidemiology; Male; Medical sciences; Middle Aged; Miscellaneous; Mycobacterium; Non tumoral diseases. Target tissue resistance. Benign neoplasms; Pneumology; Prevalence; Prevention and actions; Prospective Studies; Public health. Hygiene; Public health. Hygiene-occupational medicine; Rifampin - adverse effects; Rifampin - therapeutic use; Sub-Saharan Africa; Tuberculosis; Tuberculosis, Pulmonary - drug therapy; Tuberculosis, Pulmonary - epidemiology; Tuberculosis, Pulmonary - mortality; Malawi; Sub-Saharan Africa; Africa; Endocrinopathy; Mycobacterial infection; Epidemiology; sub-Saharan Africa; Association; Malawi; Adrenal gland diseases; Pneumology; Human; Immunopathology; hypoadrenalism; Mortality; Retroviridae; AIDS; Immune deficiency; Lentivirus; Infection; Virus; Adrenal insufficiency; Treatment; Tuberculosis; HIV; Viral disease; Bacteriosis; Human immunodeficiency virus
• ISSN: 1027-3719; 1815-7920

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.