Prevalence of tuberculosis in newly diagnosed HIV patients and its relationship with CD4 count in a tertiary care hospital

Authors

  • Archana B. Department of Pulmonary Medicine, Kempegowda Institute of Medical Sciences, Bengaluru, Karnataka, India
  • Vivek K. U. Department of Pulmonary Medicine, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India

DOI:

https://doi.org/10.18203/2349-3933.ijam20195239

Keywords:

CD4 count, Extrapulmonary tuberculosis, Pulmonary tuberculosis, Human immunodeficiency virus - tuberculosis, People living with the human immunodeficiency virus

Abstract

Background: Tuberculosis (TB) is the commonest opportunistic infection among Human Immunodeficiency Virus (HIV) positive patients in India and HIV/TB co-infection poses a major public health challenge in developing countries. It is estimated that 60-70% of HIV positive patients will develop tuberculosis in their lifetime. The aim of the present study is to record the clinical, radiological profile of pulmonary and Extrapulmonary Tuberculosis (EPTB) in HIV positive patients.

Methods: This was a prospective study conducted in the department of Pulmonary medicine, Kempegowda institute of medical sciences. All newly diagnosed HIV patients during the study period were included and screened for tuberculosis irrespective of whether they had signs and symptoms.

Results: Among 44(15.94%) patients among 276 HIV positive patients were diagnosed to have tuberculosis. Males (72.72%) were affected more than females (27.27%). Most common affected age group was 31-40 years with a mean age of 38.08 years. Unprotected heterosexual contact was the most common mode of HIV transmission. Fever, weight loss and cough were the commonest symptoms at presentation. Pulmonary TB was diagnosed in 10(22.7%) patients, EPTB in 30(68.3%) and disseminated TB in 4(9%) patients. All the pulmonary TB patients had CD4 count below 250, EPTB below 150 and disseminated TB patients below 50.6(13.63%) patients had pleural effusion, 5(11.36%) had abdominal TB, 5(11.36%) had tubercular meningitis, 4(9%) had intra thoracic lymphadenopathy and one (2.27%) patient had pericardial effusion. Low CD4 count (<150) had statically significant association with HIV/TB co-infection.

Conclusions: The prevalence of HIV-TB co-infection was high. Moreover, HIV positive patients need early diagnosis and treatment of active TB. The study has shown clear correlation between clinical data and the laboratory parameter of immunodeficiency (CD4 count) and the temporal development of TB.

References

World Health Organization. Global Tuberculosis Report 2012. Available at: https://www.who.int/tb/publications/global_report/gtbr12_main.pdf. Accessed 20 November 2017.

World Health Organization. HIV-associated TB facts 2013. Available at: https://www.who.int/tb/challenges/hiv/tbhiv_factsheet_2013_web.pdf. Accessed 4 October 2017

Crofton J. Tuberculosis undefeated. Ir J Med Sci 1985; 154(1): S45-S52.

Donald PR, Van Helden PD. The global burden of tuberculosis combating drug resistance in difficult times. New Eng J Med. 2009 Jun 4;360(23):2393-5.

Corbett EL, Watt CJ, Walker N, Maher D, Williams BG, Raviglione MC, et al. The growing burden of tuberculosis: global trends and interactions with the HIV epidemic. Archiv Int Med. 2003 May 12;163(9):1009-21.

Swaminathan S, Ramachandran R, Baskaran G, Paramasivan CN, Ramanathan U, Venkatesan P, et al. Risk of development of tuberculosis in HIV-infected patients. Int J Tube Lung Dis. 2000 Sep 1;4(9):839-44.

Sharma SK, Mohan A. Co-infection of human immunodeficiency virus (HIV) and tuberculosis: Indian perspective. Ind J Tube. 2004;51(1):5-16.

Lee C, Kernoff PA, Phillips A, Elford J, Janossy G, Timms A, et al. Serial CD4 lymphocyte counts and development of AIDS. Lancet. 1991 Feb 16;337(8738):389-92.

Fahey JL, Taylor JM, Detels R, Hofmann B, Melmed R, Nishanian P, et al. The prognostic value of cellular and serologic markers in infection with human immunodeficiency virus type 1. New Engl J Med. 1990 Jan 18;322(3):166-72.

Lange JM, de Wolf F, Goudsmit J. Markers for progression in HIV infection. AIDS. 1989 Jan 1;3(1):S153-160.

Ackah AN, Digbeu H, Daillo K, Greenberg AE, Coulibaly D, Coulibaly IM, et al. Response to treatment, mortality, and CD4 lymphocyte counts in HIV-infected persons with tuberculosis in Abidjan, Cote d'Ivoire. Lancet. 1995 Mar 11;345(8950):607-10.

Elliott AM, Luo N, Tembo G, Halwiindi B, Steenbergen G, Machiels L, et al. Impact of HIV on tuberculosis in Zambia: a cross sectional study. BMJ. 1990 Sep 1;301(6749):412-5.

Orlovic D, Kularatne R, Ferraz V, Smego Jr RA. Dual pulmonary infection with Mycobacterium tuberculosis and Pneumocystis carinii in patients infected with human immunodeficiency virus. Clini Infect Dis. 2001 Jan 15;32(2):289-94.

Lee MP, Chan JW, Ng KK, Li PC. Clinical manifestations of tuberculosis in HIV‐infected patients. Respirol. 2000 Dec 1;5(4):423-6.

Gordin FM. Mycobacterium tuberculosis infection. Dolin R, Masur H, Saag MS, eds. AIDS Therapy. 2nd ed. Philadelphia: Elsevier Science Health Division; 2003:459-474.

Whalen CC, Nsubuga P, Okwera A, Johnson JL, Hom DL, Michael NL, et al. Impact of pulmonary tuberculosis on survival of HIV-infected adults: a prospective epidemiologic study in Uganda. AIDS. 2000 Jun 16;14(9):1219.

ERIKI PR, Okwera A, Aisu T, Morrissey AB, Ellner JJ, Daniel TM. The Influence of Human Immunodeficiency Virus Infection on Tuberculosis in Kampala, Uganda1-3. Am Rev Respir Dis. 1991;143:185-7.

Goletti D, Weissman D, Jackson RW, Graham NM, Vlahov D, Klein RS, et al. Effect of Mycobacterium tuberculosis on HIV replication. Role of immune activation. J Immunol. 1996 Aug 1;157(3):1271-8.

Goletti D, Weissman D, Jackson RW, Collins F, Kinter A, Fauci AS. The in vitro induction of human immunodeficiency virus (HIV) replication in purified protein derivative-positive HIV-infected persons by recall antigen response to Mycobacterium tuberculosis is the result of a balance of the effects of endogenous interleukin-2 and proinflammatory and antiinflammatory cytokines. J Infe Dis. 1998 May 1;177(5):1332-8.

Whalen C, Horsburgh CR, Hom D, Lahart C, Simberkoff M, Ellner J. Accelerated course of human immunodeficiency virus infection after tuberculosis. Am J Resp Crit Care Med. 1995 Jan;151(1):129-35.

Zhang Y, Nakata K, Weiden M, Rom WN. Mycobacterium tuberculosis enhances human immunodeficiency virus-1 replication by transcriptional activation at the long terminal repeat. J Clin Inv. 1995 May 1;95(5):2324-31.

Whalen C, Horsburgh Jr CR, Hom D, Lahart C, Simberkoff M, Ellner J. Site of disease and opportunistic infection predict survival in HIV-associated tuberculosis. AIDS. 1997 Mar 15;11(4):455-60.

Roederer M, Dubs JG, Anderson MT, Raju PA, Herzenberg LA. CD8 naive T cell counts decrease progressively in HIV-infected adults. J Clin Inv. 1995 May 1;95(5):2061-6.

Evans TG, Bonnez W, Soucier HR, Fitzgerald T, Gibbons DC, Reichman RC. Highly active antiretroviral therapy results in a decrease in CD8+ T cell activation and preferential reconstitution of the peripheral CD4+ T cell population with memory rather than naive cells. Antiviral Res. 1998 Oct 1;39(3):163-73.

Narain JP, Lo YR. Epidemiology of HIV-TB in Asia. Ind J Med Res. 2004 Oct 1;120(4):277.

World Health Organization. Guidelines for implementing collaborative TB and HIV programmes. Available at: https://www.who.int/iris/bitstream/handle/10665/42677/WHO_CDS_TB_2003.319.pdf; Accessed 22 November 2017.

Post FA, Wood R, Pillay GP. Pulmonary tuberculosis in HIV infection: radiographic appearance is related to CD4+ T-lymphocyte count. Tubercle Lung Dis. 1995 Dec 1;76(6):518-21.

Chamie G, Luetkemeyer A, Walusimbi-Nanteza M, Okwera A, Whalen CC, Mugerwa RD, et al. Significant variation in presentation of pulmonary tuberculosis across a high resolution of CD4 strata. Inte J Tuber Lung Dis. 2010 Oct 1;14(10):1295-302.

Greenberg SD, Frager D, Suster B, Walker S, Stavropoulos C, Rothpearl A. Active pulmonary tuberculosis in patients with AIDS: spectrum of radiographic findings. Radiol. 1994 Oct;193(1):115-9.

Long R, Maycher B, Scalcini M, Manfreda J. The chest roentgenogram in pulmonary tuberculosis patients seropositive for human immunodeficiency virus type 1. Chest. 1991 Jan 1;99(1):123-7.

Lalvani A, Pareek M. Interferon gamma release assays: principles and practice. Enfermeda Infecciosas Microbiol Clin. 2010 Apr 1;28(4):245-52.

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Published

2019-11-25

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Original Research Articles