Abstract
Background: Co-infection with tuberculosis and human immunodeficiency virus (TB-HIV) remains a major global health problem, with about 1.1 million new cases of TB in HIV-positive persons reported in 2011; 79% of the reported cases were amongst patients living in Africa. Advanced immune suppression remains the most important risk factor for tuberculosis in those with HIV, but epidemiological and clinical factors have also been identified. We sought to determine the prevalence and factors associated with pulmonary tuberculosis (PTB) in antiretroviral therapy (ART)- naive HIV-infected patients seeking HIV care services at a tertiary health facility in North Central Nigeria. Methods: We compared clinical and laboratory data for 218 HIV-1 positive adults with and without a diagnosis of pulmonary tuberculosis. Results from univariate analyses informed the selection of predictors to conduct multivariate analysis to determine which factors were associated with presence of PTB-HIV co-infection. Results: The prevalence of PTB-HIV co-infection in the evaluated cohort was 9.6%. Lower CD4+ cell count and the presence of oropharyngeal candidiasis were independently associated with PTB-HIV co-infection. CD4+ cell count was strongly associated with PTB-HIV co-infection (p=0.002) with the odds of co-infection reduced by 85% in those with a CD4+ cell count >100 cells/mm3 compared to those with <100 cells/ mm3. There was a strong association between oropharyngeal candidiasis and PTB-HIV co-infection, where the odds of co-infection are about 4.5 times higher in those with oropharyngeal candidiasis than those without candidiasis (p=0.008). Conclusion: PTB was prevalent among HIV patients seeking care in our setting. Severe immune suppression and oropharyngeal candidiasis were associated with PTB-HIV co-infection in our patients at presentation. Potential implications for severe immune suppression and advanced HIV disease are a poor clinical outcome and further spread of PTB. Strategies to encourage the early diagnosis of both HIV and TB should be considered
Highlights
Human immunodeficiency virus (HIV) infection continues to be a major global health problem; a 2011 estimate indicates that 23.5 million people living with HIV resided in sub-Saharan Africa, which represents 69% of the global HIV burden [1]
We previously evaluated risk factors for TB in our population of adult patients on antiretroviral therapy (ART) and noted that poor immunologic and/or virologic response to ART and male sex were some of the risk factors for TB in ART patients [6]
CD4+ cell count was significantly associated (p=0.002) with pulmonary tuberculosis (PTB)-HIV co-infection, with the odds of co-infection reduced by 85% in those with a count >100 cells/mm3 compared to those with a count
Summary
Human immunodeficiency virus (HIV) infection continues to be a major global health problem; a 2011 estimate indicates that 23.5 million people living with HIV resided in sub-Saharan Africa, which represents 69% of the global HIV burden [1]. There were about 1.1 million new cases of HIV-positive new TB cases with 79% of them living in Africa and globally about 430,000 people died of HIV-associated TB [2]. Co-infection with tuberculosis and human immunodeficiency virus (TB-HIV) remains a major global health problem, with about 1.1 million new cases of TB in HIV-positive persons reported in 2011; 79% of the reported cases were amongst patients living in Africa. We sought to determine the prevalence and factors associated with pulmonary tuberculosis (PTB) in antiretroviral therapy (ART)naive HIV-infected patients seeking HIV care services at a tertiary health facility in North Central Nigeria
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