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Is HIV-associated tuberculosis a risk factor for the development of cryptococcal disease?

Jarvis, Joseph Na,b,c,d; Harrison, Thomas Sa,b; Corbett, Elizabeth Le,f; Wood, Robina; Lawn, Stephen Da,e

doi: 10.1097/QAD.0b013e32833547f7
Research Letters

Cryptococcal meningitis and tuberculosis are leading causes of mortality in patients initiating antiretroviral therapy in Africa. We hypothesized that a history of tuberculosis may predispose to the development of cryptococcal meningitis and examined the association using multivariate logistic regression in a cohort of patients initiating antiretroviral therapy. History of pulmonary tuberculosis was independently associated with the development of cryptococcal meningitis (odds ratio = 6.6; 95% confidence interval = 1.3–32.7) after adjustment for covariates, including CD4 cell counts. A number of potential mechanisms may underlie this association.

aDesmond Tutu HIV Centre, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa

bDepartment of Cellular and Molecular Medicine, Centre for Infection, St George's University of London, London, UK

cInfectious Diseases Research Unit, GF Jooste Hospital, South Africa

dDivision of Infectious Diseases, Department of Medicine, University of Cape Town, Cape Town, South Africa

eDepartment of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK

fMalawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi.

Received 9 October, 2009

Revised 9 November, 2009

Accepted 11 November, 2009

Correspondence to Joseph N. Jarvis, Desmond Tutu HIV Centre, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Faculty of Health Sciences, Anzio Road, Observatory 7925, Cape Town, South Africa. Tel: +27 21 650 6987; fax: +27 21 650 6963; e-mail: joejarvis@doctors.net.uk

© 2010 Lippincott Williams & Wilkins, Inc.