Abstract
International Journal of Medicine and Public Health,2019,9,4,131-136.DOI:10.5530/ijmedph.2019.4.28Published:December 2019Type:Original ArticleClinical Profile of Patients with Disseminated Tuberculosis (DTB) in Human Immune Deficiency Virus (HIV) InfectionRajneesh Thakur, Mohammed Schezan Iqbal, and Farah Schezan Rajneesh Thakur1, Mohammed Schezan Iqbal2,*, Farah Schezan3 1Department of Internal Medicine, AFMC, Pune, Maharashtra, INDIA. 2Department of Orthopaedics, AFMC, Pune, Maharashtra, INDIA. 3Bachelor of Dental Surgery, Terna Dental College, Navi Mumbai, Maharashtra, INDIA. Abstract:Background: We evaluated the clinical profile of HIV positive patients freshly diagnosed with Disseminated Tuberculosis (DTB) and assessed their response to Anti-tuberculosis treatment (ATT). Aim: To describe various clinical, radiological and pathological parameters encountered in patients of Disseminated Tuberculosis having an HIV co-infection and assessing the response to standard ATT. Settings and Design: This study is a descriptive study. Materials and Methods: We conducted a study on 54 patients of disseminated TB with HIV coinfection who were already on Anti-retroviral therapy. Assessment was focused on mode of diagnosis and distribution of organ involvement. Four months of HRZE and two months of HRE were prescribed as the standard ATT. Effect of this treatment was observed on change in weight, CD4+ counts and HIV RNA viral loads. Statistical analysis used: Wilcoxon Sign Rank Test for assessing response to ATT. Results: This study included 54 patients. The lymphatic system was the most commonly involved organ system (64.81%) and other organs involved were the liver (55.56%), the lungs (46.3%), the pleurae (12.96%), the meninges (5.54%) and the bone marrow (3.71%). Median weight at baseline was 53 kg (IQR, 49-58) and after six months of standard ATT was 62 kg (IQR, 58-67) (p<0.001). Median CD4+ count at baseline was 107.5 cells /mm3 (IQR, 51.5-150.75) and after six months of standard ATT was 246 cells /mm3 (IQR, 184-335.75) (p<0.001). Median HIV RNA viral load at baseline was 2,83,575 copies/mL (IQR, 1,78,376.25 - 3,83,370) and after six months of standard ATT was 19,916.5 copies/mL (14,376.25 - 28,622.5) (p<0.001). Conclusion: DTB in HIV positive patients has a variety of clinical manifestations which should be incorporated in the clinical decision making and change in weight, CD4+ count and HIV RNA viral load is a reliable indicator of therapeutic response in such cases. Keywords:ATT, Clinical profile, Disseminated TB, HIV, Plasma HIV RNA viral loadView:PDF (224.85 KB)
Highlights
Tuberculosis (TB) poses a significant threat to global health even today, causing the second highest mortality rates from an infectious disease worldwide, after Human Immunodeficiency Virus/Acquired Immune-Deficiency Syndrome (HIV/Acquired Immune Deficiency Syndrome (AIDS))
As Human Immune Deficiency Virus (HIV) infection progresses, Cluster of Differentiation 4 (CD4) lymphocytes decline in number and function, making the immune system less able to prevent the growth and local spread of M. tuberculosis.[2]
One patient developed progressive peripheral neuropathy, which was attributed to Isoniazid in the Anti-Tubercular Therapy (ATT) regimen and the patient was started on Tab Pyridoxine 100 mg per day and his symptoms at the end of our study showed marked improvement
Summary
Tuberculosis (TB) poses a significant threat to global health even today, causing the second highest mortality rates from an infectious disease worldwide, after Human Immunodeficiency Virus/Acquired Immune-Deficiency Syndrome (HIV/AIDS). TB and HIV are overlapping epidemics and continue to be a major public health challenge. The World Health Organization (WHO) Global Status Report 2016, reports 10.4 million new cases of TB in 2015 of whom 11% were HIV-infected.[1] This is an increase in the number of new TB cases from 9.2 million seen in 2014. We evaluated the clinical profile of HIV positive patients freshly diagnosed with Disseminated Tuberculosis (DTB) and assessed their response to Anti-tuberculosis treatment (ATT)
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