| Popis: |
Despite the success of antiretroviral therapy roll-out, one-million people still die with HIV-infection annually. In high-burden settings, tuberculosis remains the most common proximal cause of hospital admission and death in people living with HIV. In post-mortem series, 90% of fatal HIV-associated tuberculosis is ‘disseminated’. This is a form of tuberculosis which has been poorly characterised and, despite the high associated-mortality, never been the subject of interventional trials to define optimal treatment strategies. This thesis contends that the mode of severe HIV-associated tuberculosis is blood stream infection. First it is argued with reference to historical literature that blood stream dissemination is part of the natural history of post-primary tuberculosis infection, and that HIV-associated M. tuberculosis blood stream infection (MTBBSI) can be conceived of as a reversion to, and exaggerated form of this natural history. Using data from a large cohort (n=571) of HIV-infected inpatients with CD4 cell count |
