Household Air Pollution and Risk of Pulmonary Tuberculosis in HIV-Infected Adults

Author:

Katoto Patrick D.M.C.1,Bihehe Dieudonné2,Brand Amanda1,Mushi Raymond1,Kusinza Aline1,Alwood Brian W.1,Zyl-Smit Richard N. van3,Tamuzi Jacques L.1,Sam-Agudu Nadia A.4,Yotebieng Marcel5,Metcalfe John6,Theron Grant7,Pollitt Krystal J. Godri8,Lesosky Maia3,Vanoirbeek Jeroen9,Mortimer Kevin10,Nawrot Tim9,Nemery Benoit9,Nachega Jean B.5

Affiliation:

1. Stellenbosch University

2. Université Evangélique en Afrique

3. University of Cape Town

4. University of Maryland School of Medicine

5. Albert Einstein College of Medicine

6. Zuckerberg San Francisco General Hospital, University of California

7. NRF-DST Centre of Excellence for Biomedical Tuberculosis Research, Stellenbosch University

8. Yale University

9. KU Leuven

10. Liverpool School of Tropical Medicine

Abstract

Abstract Background In developing countries, millions of deaths occur annually from household air pollution (HAP), pulmonary tuberculosis (PTB), and HIV-infection. However, it is unknown whether HAP influences PTB risk among people living with HIV-infection. Methods We conducted a case-control study among 1,277 HIV-infected adults in Bukavu, eastern Democratic Republic of Congo (February 2018 – March 2019). Cases had current or recent (<5y) PTB (positive sputum smear or Xpert MTB/RIF), controls had no PTB. Daily and lifetime HAP exposure were assessed by questionnaire and, in a random sub-sample (n=270), by 24-hour measurements of personal carbon monoxide (CO) at home. We used multivariable logistic regression to examine the associations between HAP and PTB. Results We recruited 435 cases and 842 controls (median age 41 years, [IQR] 33-50; 76% female). Cases were more likely to be female than male (63% vs 37%). Participants reporting cooking for >3h/day and ≥2 times/day and ≥5 days/weekwere more likely to have PTB (aOR 1·36; 95%CI 1·06-1·75) than those spending less time in the kitchen. Time-weighted average 24h personal CO exposure was related dose-dependently with the likelihood of having PTB, with aOR 4·64 (95%CI 1·1-20·7) for the highest quintile [12·3-76·2 ppm] compared to the lowest quintile [0·1-1·9 ppm]. Conclusion Time spent cooking and personal CO exposure were independently associated with increased risk of PTB among people living with HIV. Considering the high burden of TB-HIV coinfection in the region, effective interventions are required to decrease HAP exposure caused by cooking with biomass among people living with HIV, especially women.

Publisher

Research Square Platform LLC

Reference66 articles.

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3. Global Tuberculosis Report. 2021. https://www.who.int/publications/digital/global-tuberculosis-report-2021. Accessed 8 Mar 2022.

4. Global regional et al. and national comparative risk assessment of 84 behaviornvironmental and occupational, and metabolic risks or clusters of risks for 195 countries and territories, 1990–2017: a systematic analysis for the GBD Study 2017. Institute for Health Metrics and Evaluation. 2018. http://www.healthdata.org/research-article/global-regional-and-national-comparative-risk-assessment-84-behavioral-0. Accessed 26 Jun 2019.

5. State of Global Air. 2019 Report. Institute for Health Metrics and Evaluation. 2019. http://www.healthdata.org/news-release/state-global-air-2019-report. Accessed 26 Jun 2019.

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