Persistent cough in patients using an urban chest clinic in Malawi.

In many sub-Saharan African countries, tuberculosis (TB) cases have been increasing steadily since 1985. In Malawi, they have increased by 38% from 1990 to 1993, and extrapulmonary TB increased by 79%. Among 385 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, 301 completed testing and 95% returned for their test results. Among test completers (n = 301), 280 (93%) were found to be HIV-infected. Seropositivity rates were similar for males and females, and higher for urban dwellers than for rural dwellers (94% versus 79%). TB was found in only 48 (16%) patients. Among TB patients, 33 (77%) were HIV positive. This study suggests that TB may not be the main cause of persistent cough among persons using urban chest clinics in Malawi; HIV without sputum positive TB appears to be a major contributor. Clinicians in areas of high HIV prevalence should therefore suspect other HIV-related infections in a patient with persistent cough and in whom TB has been ruled out.