PERSISTENT COUGH IN PATIENTS USING AN URBAN CHEST CLINIC IN MALAWI

In many sub-Saharan African countries, tuberculosis (TB) cases have be en increasing steadily since 1985. In Malawi, they have increased by 3 8% from 1990 to 1993, and extrapulmonary TB increased by 79%. Among 38 5 patients with a history of persistent cough presumed to be TB, 360 ( 94%) initially consented to be tested for both HIV and TB. Of these, 3 01 completed testing and 95% returned for their test results. Among te st completers (n=301), 280 (93%) were found to be HIV-infected. Seropo sitivity rates were similar for males and females, and higher for urba n dwellers than for rural dwellers (94% versus 79%). TB was found in o nly 48 (16%) patients. Among TB patients, 33 (77%) were HIV positive. This study suggests that TB may not be the main cause of persistent co ugh among persons using urban chest clinics in Malawi; HIV without spu tum positive TB appears to be a major contributor. Clinicians in areas of high HIV prevalence should therefore suspect other HIV-related inf ections in a patient with persistent cough and in whom TB has been rul ed out.