Prevalence of HIV Infection in Tuberculosis Patients and the Predictors of HIV Co-Infection

Bathragiri, M (2006) Prevalence of HIV Infection in Tuberculosis Patients and the Predictors of HIV Co-Infection. Masters thesis, Madras Medical College, Chennai.


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INTRODUCTION: Tuberculosis continues to be a major public health problem in India. 30 percent of the population are infected with tubercle bacilli. The factors attributed for this are poor quality of life, poor housing, overcrowding, population explosion, undernutrition, lack of education, large families, early marriage, lack of awareness. Added to these factors is the increasing incidence of HIV infection in developing countries. As HIV infection decreases cell mediated immunity, it predisposes to active tuberculosis in previously infected people. So HIV infection can increase the morbidity and mortality due to active tuberculosis and the socio economic burden. Even in developed countries where tuberculosis was under control, with increasing incidence of HIV infection there is resurgence of tuberculosis. Tuberculosis appears early in the course of HIV infection before the appearance of other manifestations of the disease and opportunistic infections. so the center for disease control, has advised to screen all tuberculosis patients for HIV confection. In developing countries like India, where tuberculosis is endemic whether the same rule has to be followed remains unanswered. Studies done in various parts of the country regarding seroprevalence of HIV infection shows prevalence ranging from 1% to 10%. The factors which predict the HIV co-infection in tuberculosis patients are also not clearly known. Approximately one third of the 36 million HIV infected persons in the world are co-infected with M.Tuberculosis. 75% of these people reside in sub-Saharan Africa patients with HIV are at greater risk of reactivating latent infection (7-10% annual risk compared to 5-10% lifetime risk in an HIV - uninfected individual), of acquiring TB from an open contact (10-20% compared to 5-10%), of developing progressive primary disease (30-40% compared to 5-10%) and of developing disseminated, miliary on extrapulmonary disease (>60% compared to <25%). The purpose of the study is to find out the seroprevalence of HIV infection in tuberculosis patients and to find out the predictors of HIV co-infection. OBJECTIVES: 1. To find out the seroprevalnece of HIV infection in Tuberculosis patients (Pulmonary and extrapulmonary) admitted in Govt. General Hospital, Chennai. 2. Ton find out the factors associated with HIV co-infection in Tuberculosis patients. MATERIALS AND METHODS: Study Design: Cross sectional study of one hundred tuberculosis patients. Study Population: Patients admitted with suspected Tuberculosis in General Medical wards Govt. General Hospital, Chennai. Study Duration: October 2005 to January 2006. The study was initiated in October 2005 for the purpose of finding the prevalence of HIV infection among tuberculosis patients and the factors associated with HIV infection in tuberculosis patients. One hundred tuberculosis patients admitted in general medicine wards were studied. Inclusion Criteria: 1. Patients who have radiological or bacteriological evidence of active Pulmonary Tuberculosis. 2. Meningitis patients with CSF analysis suggestive of Tuberculous meningitis. 3. Patients with exudative ascites with laparoscopic evidence of peritoneal Tuberculosis. 4. Histologically proved tuberculous lymphadenitis patients. Exclusion Criteria: 1. Old inactive pulmonary tuberculosis patients 2. Patients whose HIV status is already known. SUMMARY: Among the hundred Tuberculosis patients studied 6 were positive for HIV infection. Duration of symptoms in HIV positive patients varied from 1 month 10 months. Three of them had chronic diarrhea. Weight loss of more than 20 percent is a consistent finding in all the HIV positive patients though it is seen in most of tuberculosis patients to a lesser extent. Among 6 HIV positive patients, 5 patients having pulmonary Tuberculosis. Extensive Pulmonary Tuberculosis was seen in 4 patients. Pleural effusion was seen in one patient. Cavitating lesions were seen in only one patient. Hemogram and Erythrocyte sedimentation rat findings were similar in HIV positive and HIV negative patients. They were not contributory. Among six human immune deficiency virus positive patients, five of them having pulmonary Tuberculosis. In these five patients one patient having sputum AFB positive (20%). So confirming the diagnosis may require sputum culture. Mantoux test was not positive (> 5mm) in any of the HIV positive patient. It was positive in only 43 of 94 HIV negative patients and it could not be depended upon for diagnosis of tuberculosis in both groups. One of the HIV positive patients in the study had extra pulmonary tuberculosis. CONCLUSION: The prevalence of HIV infection among Tuberculosis patients in this study is 6%. As Tuberculosis is an early AIDS defining illness, it is mandatory to screen all tuberculosis patients for HIV infection and is being followed in western countries. Though it is difficult to do the same in our country because of the high prevalence of Tuberculosis, prevalence of HIV infection among tuberculosis patients is rising. This study has showed a prevalence of 6%. Pulmonary Tuberculosis continues to be the dominant form. Only one HIV Positive patients had extrapulmonary tuberculosis in this study. The management of tuberculosis patients is not complete if they are not screened for HIV in the presence of following features. 1. Weight loss of more than 20% 2. History of multiple sexual partners, injection drug abuse, blood transfusion, Sexually Transmitted Diseases. 3. Atypical chest X-ray findings like lower lobe involvement, extensive parenchymal involvement, hilar mediastinal lymphadenopathy. 4. Extrapulmonary tubeculosis. 5. Chronic diarrhea.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Prevalence ; HIV Infection ; Tuberculosis Patients ; Predictors ; HIV Co-Infection.
Subjects: MEDICAL > General Medicine
Depositing User: Subramani R
Date Deposited: 24 Mar 2018 17:32
Last Modified: 25 Mar 2018 03:02

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