Abstract
There is a general broad knowledge surrounding the possible complications and opportunistic infections that patients with HIV can be exposed to, one of which is Tuberculosis, a popular co-morbid disease in HIV patients. Several studies have unraveled the efficacy of ARVs on the CD4 counts in HIV patients, but there exists knowledge gap in establishing the efficacy of ARV therapy among HIV patients with Tuberculosis (TB). The main objective of this study was to compare the efficacy of antiretroviral therapy on HIV positive patients with and without tuberculosis. A quasi-experimental design was employed in this study. Eighty (80) patients were recruited in total from the ARV-TB clinic of general hospital Bida. Forty (40) HIV patients without TB, and HIV patients with TB were recruited consecutively into group A and B respectively. Each group participants’ baseline CD4 counts were estimated and recorded, after which both groups were subjected to a six weeks ARV therapy. Data were collected weekly (for six weeks) by conducting laboratory test of CD4 counts for both groups’ patients. The data were analyzed using SPSS version 25.0 software. Descriptive statistics of mean, standard deviation and percentages were used to summarize the data, while inferential statistics of t-test, ANOVA, ANCOVA and Bonferoni pairwise comparison were used to test the significant differences as appropriate. Alpha level was set at 0.05. The study revealed that the CD4 count of HIV patients without TB (group A) at baseline was found to be statistically significantly higher than those with TB (group B), and also revealed a statistical significant difference in the CD 4 count across the seven-time-point period of the study (baseline and the six weeks of ARV therapy) in the two groups (P<0.05). The study also revealed that there was no statistically significant difference in the CD4 count of groups A and B comparatively after six weeks of ARV therapy. Recommendations among others include; extension of the study tentacle to increased number of health facilities and longer study period, conducting studies on the impact of the dual therapy (ARV and anti-TB) on the co-infected patients, and the need for all stakeholders involved in the treatment of HIV patients to continuously update their knowledge base on the management of the HIV patients with and without TB, for a more productive and goal-oriented treatment outcome, void of sentiments and discrimination.
Highlights
There are cases of Human Immunodeficiency Virus (HIV) co-infected with TB with few cases of co-infected multi-drug resistance tuberculosis (MDR-TB) in Bida local government area of Niger state, Nigeria, most of these cases are among those HIV positive patients who are not regular on clinic visit as well as not Highly Active Antiretroviral Therapy (HAART) drug compliance or those presented lately
This study showed that Group A (HIV without TB) had statistically significantly higher mean baseline CD4 count (p < 0.001) than those in Group B (HIV co-infected with TB), this could be due to the dual disease burden effect of the HIV and tuberculosis in group B
TB co-infection with HIV commonly occur at low CD4 count in HIV positive patients as seen in the work done by Nwabuko. et al [11] which showed an inverse relationship between CD4 count and the occurrence of tuberculosis of HIV patient co-infected with TB and for the fact that co-infected patients has slower rate of CD4 recovery when compare with HIV patients without TB as reported by Penelope et al
Summary
A lentivirus responsible for HIV infection and overtime without any intervention leads to Acquired immunedeficiency Disease syndrome (AIDs). An individual with HIV has compromised immunity and are prone to several opportunistic infections especially tuberculosis. Average survival time after being infected with HIV without any intervention is between 9-11 years [1]. Acquisition of HIV infection is majorly through sexual contact, others are sharing of sharps, vertical transmission from mother to child, blood transfusion and others. HIV infection majorly affects the CD4 T-cell, untreated HIV reduces the number of CD4cell in the body leading to damage of the immune system, making it harder for the body to fight off infection and some other disease, [2] the need for monitoring infected patient CD4-cells, other cells affected by HIV are the macrophages and dendritic cells.
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