TUBERCULOSIS AND HIV COINFECTION AT ANANTA INSTITUTE OF MEDICAL SCIENCES AND RESEARCH CENTER

Abstract

INTRODUCTION: About 60 per cent of TB cases and deaths occur among males, but the disease burden is also high among women also. In 2015 nearly 500,000 women died from TB, and among them, 28 per cent had human immunodeficiency virus (HIV) co-infection. Tuberculosis (TB) is a bacterial disease caused by Mycobacterium tuberculosis (M. tuberculosis), which mostly manifests as pulmonary TB but it can affect other organs called as extra-pulmonary Tuberculosis (ETB). TB is expanding public health issue amongst the developing countries, due to HIV pandemic, poverty, movement of displaced people and emergence of multidrug-resistant strains and it is evidenced that, in most of the developing countries, HIV pandemics, diabetes, malnutrition, alcoholism, smoking cigarette, active TB contact, extreme poverty, and homelessness are common identified risk factors pertaining to tuberculosis. MATERIAL AND METHODS: Patients who presented with cough lasting for 2 weeks, evening rise of temperature, weight loss or more were clinically suspected of having TB. Laboratory and radiological investigations were carried out. Laboratory investigation for TB was by sputum smear for acid-fast bacilli (AFB) and who had at least one smear positive for AFB were categorized as smear-positive pulmonary TB (PTB). Chest X-ray was done to detect radiological changes of PTB. Extra-pulmonary tuberculosis included tuberculosis of organs other than the lungs, such as the abdomen, genitourinary tract, lymph nodes, skin, bones, joints, and meninges. A diagnosis of extra pulmonary tuberculosis (EPTB) was made based on clinical findings suggestive of TB, radiology, cytology, and tissue histology. RESULTS: A total of 100 TB patients were included in the study. Age range was 15 to 59 years with mean age 37 ±15.9 years. HIV coinfection was found in 15 patients age range was 24 to 49 years with mean age 35 ±12.9 years. More than a half (n=10; 54.3%) of participants had CD4 count ranged between 200-500/?l and 21.6% (n=63) of respondents had CD4 count <200/?l. In addition, the study also showed that 29.2% (n=85) and 3.7% (n=11) . Of the 15 HIV positive diagnosed cases 5 were relapse case (33.33%) of which 2 were female and 3 were male . 10 cases (66.67%) were new cases of which 3 were female and 7 were male.MDR TB ( multidrug resistant TB) was seen in 10 cases of HIV co infected patients as compared to HIV negative it was 15 cases. CONCLUSION: Drug-resistant TB is becoming a significant challenge to the control of the infection in the world especially in HIV-positive patients. Treatment should be targeted at treating the immune suppression associated with HIV which promotes development of active TB. Previous history of TB, CD4 count less than 200/?l were the possible risk factors.

KEYWORDS: TB, HIV, CD4 and ETB.