A Study of Clinical Profile of Recurrent Tuberculosis in People Living with HIV/AIDS

Abstract

Background: Tuberculosis (TB) is a common infection in an endemic country like India and a major cause of mortality in people living with HIV/AIDS (PLHA). Primary objectives: To study the prevalence of recurrent TB in patients of HIV/TB coinfection. Secondary objective: 1) To study the clinical profile of recurrent TB cases. 2) To study the factors associated with recurrence of TB in patients of HIV/TB co-infection. Materials and method: This retrospective observational study was conducted at a tertiary care hospital in Pune, India between November 2014 to August 2016 in which case records of 185 patients with known HIV/TB co-infection were studied for the clinical and immunological status during initial presentation and during recurrence TB. Results: The prevalence of recurrent TB in this study was 34.59% (64 subjects). The average time to recurrence was 34.27 months. Occurrence of disseminated or sputum negative pulmonary TB during initial TB illness was significantly associated with recurrence of TB (RR of 0.325 (0.18-0.58) and RR of 2.45 (1.68-3.57) respectively. The 6-month anti-tuberculosis therapy (ATT) regimen was significantly associated with recurrence of TB as compared to 9 month of ATT (p value<0.001, OR 0.0029 ). Conclusion: Recurrent TB is a significant clinical problem in HIV positive patients. Male sex, sputum negative pulmonary TB or disseminated infection at the first instance of TB, a high Mantoux reading at initial TB presentation (≥ 20 mm) and shorter duration of ATT (6 months versus 9 months) are all significant risk factors for recurrence.