Effect of HIV-1 infection on tuberculosis and fertility in a large workforce in Kinshasa, Democratic Republic of the Congo

To determine the effect of an HIV counseling service on the incidence of HI V and tuberculosis infection and on the fertility rate in a large workforce cohort of adult men and women from Kinshasa, Democratic Republic of Congo (formerly Zaire), we conducted a 2-year prospective longitudinal cohort stu dy, two large Kinshasa businesses (a commercial bank and a textile factory) . We determined baseline HIV-1 seroprevalence, HIV-1 and tuberculosis morta lity/morbidity, and fertility rates during 24 months of follow-up on 8866 e mployees and 6411 wives of male employees. The baseline HIV-1 seroprevalenc e was 2.8% in male employees (n = 6657), 8.4% in female employees (n = 417) , and 2.4% in the wives of male employees (n = 4692). The HIV-1 seroinciden ce per 100 person-years of follow-up in these three groups was 0.9, 0.5 and 0.8, respectively. The incidence of tuberculosis was 2.4/100 person years in persistently seropositive individuals compared with a 0.38 rate in persi stently seronegative individuals (p < 0.01). The annual fertility rate in p ersistently seronegative women was 250.0/1000 women compared with a rate of 140/1000 in persistently seropositive women (p < 0.001). Forty-eight (44%) of 105 male employees and 17 (26%) of 60 wives of male workers who died du ring follow-up were HIV-1 seropositive. HIV infection was responsible for n early one half of all deaths in this large workforce. Tuberculosis incidenc e was six times higher in HIV-1-infected compared with uninfected individua ls. Counseling of HIV-infected women and their husbands appeared to be effe ctive as their cumulative fertility rate was 44% lower than the rate in sim ilarly aged uninfected women.