Manifestation of tuberculosis in HIV/AIDS patients and its relationship with CD4 count

Abstract

Background: Tuberculosis (TB) is said to be one of the commonest opportunistic infection among human immunodeficiency virus (HIV) seropositive. Varied clinical manifestations have been observed according to immune status of HIV positives. Aims & Objective: The present study aims to relate the clinical, radiological and laboratory profiles of patient with HIV/TB co-infection and its correlation with CD 4 count. Material and Methods: Seventy adult TB patients having confirmed HIV seropositivity were included. A detailed history, physical examination, laboratory and radiological investigations were carried out. Results: Maximum numbers of patients were from age group of 21–40 years. Commonest mode of HIV was heterosexual route (80 %). Male: Female ratio was 4:1. Most of the patients (45.71%) were labour workers, followed by housewife (20%), sales man (18%), textile worker (8.8%), and transport driver (8.8%). Fever (75.71%), weight loss (68.57%) and decrease appetite (65.57%) were predominant symptoms. Pulmonary TB (PTB) was found in 24.28% patients, while extra-pulmonary TB (EPTB) in 75.72% patients. Most of Pulmonary TB had CD 4 count > 180, while in extra-pulmonary TB most of patients had CD 4 count < 180. Commonest form of EPTB was disseminated TB (30%) followed by abdominal TB (21.42%), tuberculous lymphadenopathy (12.85%) and CNS tuberculosis (4.28%). Positive smear for acid-fast bacilli (AFB) was found in 17.14% patients of PTB. The mean CD4 count at presentation were 214 cells/μl, 182.47 cells/μl, 175.22 cells/μl and 54.66 cells/μl in tubercular meningitis, abdominal TB, tuberculosis lymph node TB and disseminated TB respectively. Conclusion: HIV/TB co-infection is more common in sexually active age group and commonest mode of HIV infection is heterosexual transmission. Sputum smear AFB test positivity is low in TB patients having HIV. Disseminated TB is common in advanced HIV cases as CD 4 count decreases.