Gender and HIV-associated pulmonary tuberculosis: Presentation and outcome at one year after beginning antituberculosis treatment in Uganda

Background: Tuberculosis is responsible for more female deaths around the earth than any other infectious disease. Reports have suggested that responses to tuberculosis may differ between men and women. We investigated gender related differences in the presentation and one year outcomes of HIV-infected adults with initial episodes of pulmonary tuberculosis in Uganda. Methods: We enrolled and followed up a cohort of 105 male and 109 female HIV-infected adults on treatment for initial episodes of culture-confirmed pulmonary tuberculosis between March 1993 and March 1995. A favorable outcome was defined as being cured and alive at one year while an unfavorable outcome was not being cured or dead. Subjects were followed-up by serial medical examinations, complete blood counts, serum β₂ microglobulin, CD4+ cell counts, sputum examinations, and chest x-rays. Results: Male patients were older, had higher body mass indices, and lower serum β₂ microglobulin levels than female patients at presentation. At one year, there was no difference between male and female patients in the likelihood of experiencing a favorable outcome (RR 1.02, 95% Cl 0.89-1.17). This effect persisted after controlling for symptoms, serum β₂ microglobulin, CD4+ cell count, and severity of disease on chest x-ray (OR 1.07, 95% Cl 0.54-2.13) with a repeated measures model. Conclusions: While differences existed between males and females with HIV-associated pulmonary tuberculosis at presentation, the outcomes at one year after the initiation of tuberculosis treatment were similar in Uganda. Women in areas with a high HIV and tuberculosis prevalence should be encuraged to present for screening at the first sign of tuberculosis symptoms.