Erythrocyte sedimentation rate may be an indicator for screening of tuberculosis patients for underlying HIV infection, particularly in resource-poor settings: an experience from India.

Abstract

Sir,India has been experiencing the most serious publichealth challenge caused by HIV epidemic since its first detection in 1986 (1). The country has an estimated 4.58 million HIV-infected individuals (2). Prevalence data on HIV infection collected from various parts of the country indicate its spread from urban to rural areas and from high risk to general population (3). Because of continued HIV transmission in the community for the last many years, the country is witnessing several opportunistic infections associated with HIV infection, of which tuberculosis (TB) is the most prominent.Early detection and effective treatment with regular follow-up until complete recovery is the most important strategy to control the spread of tuberculosis in the community. India needs special attention to control TB as the country harbours a large number of TB patients and many of whom are associated with HIV infection. The effects of HIV on TB include: (a) More transmission of TB bacteria in the community, (b) TB progresses faster in HIV-infected people, and (c) TB in HIV-positive people is more likely to be fatal if diagnosed late or left untreated (4).Unfortunately, the HIV status of a sizable number of tuberculosis patients detected by the local physicians remains unknown due to the shortage of HIV testing facilities. The present study, conducted at the National Institute of Cholera and Enteric Diseases (ICMR), Kolkata, India, was aimed at finding a positive predictive factor in tuberculosis patients, particularly in resource-poor settings, so that underlying HIV could be detected to a great extent using minimum diagnostic resources.Data of routine investigations of 34 pulmonary tuberculosis patients associated with HIV infection, diagnosed during July-December 2003, were reviewed. The routine investigations included total count (TC), differential count (DC), haemoglobin (Hb), erythrocyte sedimentation rate (ESR), and mode of diagnosis. The data were compared with data from a similar group of pulmonary tuberculosis patients (n=25), who were detected during the same time but not associated with HIV infection.There was not much difference in basic investigations between these two groups, except in ESR values. Most tuberculosis patients with HIV infection had a much lower ESR value compared to the control group. The mean and median values of ESR, respectively, were 38.5 mm per hour and 30.0 mm per hour among patients with HIV infection (n=34) compared to 102 mm per hour and 108 mm per hour among those without HIV infection (n=25).Table 1 shows the relationship between TB with or without HIV infection and ESR status, and Table 2 shows the age distribution of TB subjects of both the groups. …