HIV-TB Co-infection Research Articles

Pulmonary Tuberculosis among HIV/AIDS Patients: Chest X-ray Characteristics

Tuberculosis (TB) and human immunodeficiency virus (HIV) constitute the main burden of infectious disease worldwide. Infection with HIV increases an individual’s risk to 20-fold of developing active TB. Chest X-ray (CXR) is one of the important tools used in the diagnosis of pulmonary tuberculosis among people living with HIV/AIDS. The spectrum of radiological findings varies according to HIV status and immunological status. This review designed to identify the common CXR findings encountered in pulmonary TB-HIV coinfection. The electronic search was in two main databases PubMed, Scopus, and Google Scholar were conducted using the search term: “Chest X-ray/radiological features/ Findings/ characteristics, pulmonary TB and HIV/AIDS co-infection”. It was found that typical radiological finding is closely related to the immunological status, where the atypical presentations were commonly reported in PTB-HIV confection. It could be included that interpretation of CXR in areas with a high prevalence of HIV-related TB necessitates interpreters to be provided with HIV status and the degree of immunosuppression.

Immune Network Analysis Reveals Interleukin-17A Related Responses As Key Contributors to HIV-1 Associated Tuberculosis

Background: Human immunodeficiency virus type 1 (HIV-1) mediated dysregulation of the immune response to TB and its effect on the response to antitubercular treatment (ATT) is incompletely understood. We performed in-depth analysis of the inflammatory profile of HIV-1-uninfected and co-infected TB patients undergoing ATT, with sub-analysis of the effect of antiretroviral therapy and HIV-1 viraemia in the latter group. Methods: A panel of 39 cytokines, acute phase proteins and soluble receptors were measured in plasma of a cohort of patients with pulmonary TB undergoing ATT in South Africa. We applied basic and advanced statistical analysis, including network and multivariate analysis, to investigate the dynamic inflammatory profile of TB patients during ATT. Findings: HIV-1 status markedly influenced the inflammatory profile regardless of ATT duration, with HIV-1 viral load driving differential inflammatory marker expression and correlation profiles observed in the HIV-1 co-infected group. Unexpectedly, IL-17A emerged as a key correlate of HIV-1 induced inflammation during HIV-TB co-infection. We validated these findings in a second cohort of hospitalized HIV-TB co-infected patients where the number of statistically significant correlations with this cytokine in network analysis predicted mortality. Interpretation: Our findings demonstrate the effect of HIV-1 co-infection on the complexity of plasma inflammatory profiles in TB patients. Through network analysis we identified IL-17A as an important node in HIV-TB co-infection, thus implicating this cytokine’s capacity to correlate with, and regulate, other inflammatory markers. Funding Statement: National Institutes of Health The Wellcome Trust UK Research and Innovation Cancer Research UK European and Developing Countries Clinical Trials Partnership South African Medical Research Council Declaration of Interest: The funders had no role in study design, data collection and interpretation, or the decision to submit the work for publication. The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. Ethical Approval Statement: The University of Cape Town (UCT) Faculty of Health Sciences Human Research Ethics Committee (HREC) approved the study (568/2012) and written informed consent was obtained from all study participants. The validation cohort involved hospitalized HIV-TB co-infected patients (UCT HREC 057/2013) who also provided written informed consent when possible. Hospitalized patients who were eligible for study participation but could not immediately provide informed consent due to decreased level of consciousness were enrolled and followed up daily until they regained the capacity to participate in the informed consent process. UCT HREC approved the per-protocol use of samples and information from those who died before providing informed consent, or who could not provide consent by the end of study follow-up. HIV-1 infected healthy controls with no evidence of active TB were also enrolled (UCT HREC 057/2013) and provided written informed consent.

Tuberculosis deaths are predictable and preventable: Comprehensive assessment and clinical care is the key

The goal of reducing tuberculosis (TB) mortality in the END TB Strategy can be achieved if TB deaths are considered predictable and preventable. This will require programs to examine and address some key gaps in the understanding of the distribution and determinants of TB mortality and the current model of assessment and care in high burden countries.Most deaths in high-burden countries occur in the first eight weeks of treatment and in those belonging to the age group of 15–49 years, living in poverty, with HIV infection and/or low body mass index (BMI). Deaths result from extensive disease, comorbidities like advanced HIV disease complicated with other infections (bacterial, fungal, bloodstream), and moderate-severe undernutrition. Most early deaths in patients with TB, even with TB-HIV co-infection, are due to TB itself.Comprehensive assessment and clinical care are a prerequisite of patient-centered care. Simple independent predictors of death like unstable vital signs, BMI, mid-upper arm circumference, or inability to stand or walk unaided can be used by programs for risk assessment. Programs need to define criteria for referral for inpatient care, address the paucity of hospital beds and develop and implement guidelines for the clinical management of seriously ill patients with TB, advanced HIV disease and severe undernutrition as co-morbidities. Programs should also consider notification and audit of all TB deaths, similar to audit of maternal deaths, and address the issues in delays in diagnosis, treatment, and quality of care.

7-oxo-DHEA enhances impaired M. tuberculosis-specific T cell responses during HIV-TB coinfection

BackgroundMycobacterium tuberculosis (Mtb) is the causative agent of tuberculosis (TB), affecting approximately one third of the world’s population. Development of an adequate immune response will determine disease progression or progress to chronic infection. Risk of developing TB among human immunodeficiency virus (HIV)-coinfected patients (HIV-TB) is 20–30 times higher than those without HIV infection, and a synergistic interplay between these two pathogens accelerates the decline in immunological functions. TB treatment in HIV-TB coinfected persons is challenging and it has a prolonged duration, mainly due to the immune system failure to provide an adequate support for the therapy. Therefore, we aimed to study the role of the hormone 7-oxo-dehydroepiandrosterone (7-OD) as a modulator of anti-tuberculosis immune responses in the context of HIV-TB coinfection.MethodsA cross-sectional study was conducted among HIV-TB patients and healthy donors (HD). We characterized the ex vivo phenotype of CD4 + T cells and also evaluated in vitro antigen-specific responses by Mtb stimulation of peripheral blood mononuclear cells (PBMCs) in the presence or absence of 7-OD. We assessed lymphoproliferative activity, cytokine production and master transcription factor profiles.ResultsOur results show that HIV-TB patients were not able to generate successful anti-tubercular responses in vitro compared to HD, as reduced IFN-γ/IL-10 and IFN-γ/IL-17A ratios were observed. Interestingly, treatment with 7-OD enhanced Th1 responses by increasing Mtb-induced proliferation and the production of IFN-γ and TNF-α over IL-10 levels. Additionally, in vitro Mtb stimulation augmented the frequency of cells with a regulatory phenotype, while 7-OD reduced the proportion of these subsets and induced an increase in CD4 + T-bet+ (Th1) subpopulation, which is associated with clinical data linked to an improved disease outcome.ConclusionsWe conclude that 7-OD modifies the cytokine balance and the phenotype of CD4 + T cells towards a more favorable profile for mycobacteria control. These results provide new data to delineate novel treatment approaches as co-adjuvant for the treatment of TB.

Dynamics of HIV-TB co-infection with detection as optimal intervention strategy

In this paper, a HIV/AIDS and TB co-infection model has been explored, which incorporates detection and treatment for both diseases. We begin with presenting a co-infection model and then start analyzing both the HIV and the TB sub-models separately. The basic reproduction numbers corresponding to both HIV and TB are computed. Both the HIV/AIDS and the TB sub-models have been shown to exhibit two equilibrium points, namely, the disease-free equilibrium point and the unique endemic equilibrium point. For both sub-models, the disease-free equilibrium point is locally as well as globally asymptotically stable when their corresponding reproduction number is less than unity. The endemic equilibrium point for both sub-models exists, when their corresponding reproduction numbers is greater than one. We also analyze the full HIV-TB co-infection model. With the aim of minimizing infectives and the cost of applying effort towards the detection and the treatment, optimal control analysis is performed for the full model using the Pontryagin’s maximum principle. Numerical simulations with different combinations of efforts are then performed to explore the effect of detection in the presence of treatment for both diseases. Numerical simulations emphasize the fact that to reduce co-infection from the population, programs to accelerate the detection of both diseases are also required along with the treatment.

HIV-TB co-infection with clinical presentation, diagnosis, treatment, outcome and its relation to CD4 count, a cross-sectional study in a tertiary care hospital in coastal Karnataka

Introduction:Tuberculosis (TB) is the leading killer and the commonest opportunistic infection (OI) in human immunodeficiency virus (HIV) infected individuals with 0.3 million deaths in 2017. When HIV and TB co-infection occurs, they form a deadly combination with each accelerating the progression of the other, resulting in increased morbidity and mortality.Aim and Objectives:To study the demographic pattern, clinical presentation, opportunistic infections, radiological and laboratory profile, management, and outcome of HIV-TB coinfected individuals.Materials and Methods:A prospective cross-sectional study was carried out on confirmed HIV cases already diagnosed with TB and those newly detected with TB after admission, where diagnosis was carried out following standard operative procedures.Results:In our study of 58 HIV-TB co-infected individuals, 40–50 years was the most common age group affected. Males were affected more with majority being married. The most common presentation was fever (67%) followed by gastrointestinal symptoms. Majority of TB cases were newly diagnosed (65.5%), with predominance of pulmonary tuberculosis (PTB) (n = 35) followed by those having only extrapulmonary tuberculosis (EPTB) (n = 12) and both (n = 11). TB was diagnosed by microscopy in 32.7%, while radiologically, chest X-ray was most common (36.2%). Also, 50% were infected with other OIs where oral candidiasis was the most common (37.93%). The overall mean CD4 count was 220 cells/μL and those with EPTB had lesser CD4 counts than those with PTB. All were on DOTS regimen and majority showed improvement.Conclusion:In a country like India where both these diseases are rampant, we recommend better information, education, understanding and awareness for prevention, care, early diagnosis, and treatment of these two notorious infectious diseases with prevention of relapse and default of TB cases in HIV-TB co-infected individuals a priority.

Oral Manifestations in HIV-TB Co- infected Patients and Their Correlation with CD4 Count in Telangana State, India.

Aims and Objectives:Human immunodeficiency virus (HIV)-related oral lesions are often an early finding, and they reflect the underlying immunosuppression, and tuberculosis (TB) coinfection can have further deteriorating effect. Hence, a cross-sectional study was conducted to evaluate clinical and oral presentations of patients coinfected with HIV–TB, correlating with various parameters such as the type of TB with CD4 cell count, the type of TB with oral manifestations, site of the lesion, oral manifestations with CD4 cell counts, age, and gender.Materials and Methods:A cross-sectional study was conducted among selected 200 patients coinfected with HIV–TB, registered at Gandhi Medical College, Hyderabad, Telangana, India, and demographic data, CD4 count, diagnosis of TB, and clinical presentation of TB were correlated with site, age, gender, and the type of lesions in the oral cavity. Data were analyzed using the Statistical Package for the Social Sciences (SPSS) software, (IBM SPSS), version 20 (Chicago, IL, USA), with the chi-square test, and the significant P value for all the parameters was considered as <0.05.Results:A total of 200 patients with HIV–TB coinfection, who presented with oral lesions of 258 coinfected cases, were examined. Among which, 129 patients were with pulmonary tuberculosis (PTB), 61 patients with extrapulmonary TB, 2 patients with disseminated TB, and 8 patients with PTB and pneumonia. There were multiple oral manifestations involving different sites of oral cavity, oral candidiasis (28.5%), angular cheilitis (24.5%), linear gingival erythema (21.5%), oral hairy leukoplakia (1.5%), melanotic pigmentation (29.0%), ulcers (20.0%), depapillation of tongue (26.5%), lobulated tongue (12.0%), hairy tongue (11.5%), and papules (10.0%). The correlation of the type of TB with CD4 cell count, oral lesions with the type of TB in tongue, labial mucosa, and palate was significant.Conclusion:A total of 77.5% patients coinfected with HIV–TB had shown oral manifestations emphasizing that the presence of oral lesions can be considered as a strong indicator of coinfection. The oral lesions might be used as a clinical indicator or screening mechanism in patients who were HIV seropositive for TB coinfection and should be necessarily evaluated for TB.

Epidemiological profile of HIV patients attending ARTC of a tertiary care hospital in Jaipur, India

Introduction: District Jaipur of Rajasthan has a high prevalence of Human Immunodeficiency Virus (HIV) and it comes under category B of HIV transmission. The geographical and sociocultural environments of different states of India are different; hence, the profile of HIV cases also differs from place to place. Area-specific data regarding the profile of HIV cases attending the biggest government hospital of Jaipur could be utilized by higher authorities for the implementation of control measures. Objective: The objective was to describe the sociodemographic profile of HIV cases and to find out the comorbidity of TB-HIV cases. Materials and Methods: The hospital-based, observational, and descriptive study was undertaken at a tertiary care teaching hospital of Jaipur from 1 January to 28 February 2019. Primary data were collected from 220 HIV-positive cases through an interview, and secondary data were collected from case records. Results: The maximum cases (40%) were in the age group of 31 to 40 years. Around 30% of cases were unmarried, widows, or divorced. Half of them were from the below poverty line (BPL) families. Only 9% of patients had a college education. Every third case reported was a housewife. Around 13% of cases were not aware of their spouse’s HIV status. HIV-TB coinfection was present in 20% of cases. Conclusion: The majority of cases were from the sexually active age groups and were poor, unmarried, widows, or divorced, and housewives. The spouse of every eighth case was unaware of the HIV status of their partner. Tuberculosis (TB) was the most common coinfection. This basic information would help policymakers formulate better information, education and communication and control measures that are area and population specific.

HIV–TB co-infection treatment control using multi-objective optimized sliding mode

Abstract Mycobacterium tuberculosis (MTB) and Human immunodeficiency virus (HIV) are two causes of infection which threaten human health over recent decades. There is abundant evidence indicating that these diseases are related to each other. People living with HIV have a 30-fold increase in tuberculosis infection compared to healthy people. In recent years, medical researchers and other specialists including engineers and basic scientists have tried to propose treatments for dangerous diseases by means of mathematical simulation. In this paper, a mathematical model of the HIV-TB co-infection individuals is regarded in order to represent different characteristics of such people. In the next step, a sliding mode controller is implemented on first and second HIV treatment rates to minimize the Total Burden resulted from the co-infection. Moreover, the multi-objective genetic algorithm (MOGA) is used to optimize the sliding mode controller coefficients. The MOGA is accurate and resilient and its Pareto front has a reasonable variety. In this method, designers acceptably use defeated points with more than one objective function and are also able to choose appropriate solutions according to their preferences. The results suggest that disease deaths, new infections, and immune reconstitution inflammatory syndrome cases play an important role in the problem.

Using Statistical Learning to Treat Missing Data: A Case of HIV/TB Co-Infection in Kenya

In this study, we investigate the effects of missing data when estimating HIV/TB co-infection. We revisit the concept of missing data and examine three available approaches for dealing with missingness. The main objective is to identify the best method for correcting missing data in TB/HIV Co-infection setting. We employ both empirical data analysis and extensive simulation study to examine the effects of missing data, the accuracy, sensitivity, specificity and train and test error for different approaches. The novelty of this work hinges on the use of modern statistical learning algorithm when treating missingness. In the empirical analysis, both HIV data and TB-HIV co-infection data imputations were performed, and the missing values were imputed using different approaches. In the simulation study, sets of 0% (Complete case), 10%, 30%, 50% and 80% of the data were drawn randomly and replaced with missing values. Results show complete cases only had a co-infection rate (95% Confidence Interval band) of 29% (25%, 33%), weighted method 27% (23%, 31%), likelihood-based approach 26% (24%, 28%) and multiple imputation approach 21% (20%, 22%). In conclusion, MI remains the best approach for dealing with missing data and failure to apply it, results to overestimation of HIV/TB co-infection rate by 8%.

Prevalence of tuberculosis in newly diagnosed HIV patients and its relationship with cluster of differentiation 4 count in a tertiary care hospital

Background: Tuberculosis (TB) is the commonest opportunistic infection among Human Immunodeficiency Virus (HIV) positive patients in India and HIV/TB co-infection poses a major public health challenge in developing countries. It is estimated that 60-70% of HIV positive patients will develop tuberculosis in their lifetime. The aim of the present study is to record the clinical, radiological profile of pulmonary and Extrapulmonary Tuberculosis (EPTB) in HIV positive patients.Methods: This was a prospective study conducted in the department of Pulmonary medicine, Kempegowda institute of medical sciences. All newly diagnosed HIV patients during the study period were included and screened for tuberculosis irrespective of whether they had signs and symptoms.Results: Among 44(15.94%) patients among 276 HIV positive patients were diagnosed to have tuberculosis. Males (72.72%) were affected more than females (27.27%). Most common affected age group was 31-40 years with a mean age of 38.08 years. Unprotected heterosexual contact was the most common mode of HIV transmission. Fever, weight loss and cough were the commonest symptoms at presentation. Pulmonary TB was diagnosed in 10(22.7%) patients, EPTB in 30(68.3%) and disseminated TB in 4(9%) patients. All the pulmonary TB patients had CD4 count below 250, EPTB below 150 and disseminated TB patients below 50.6(13.63%) patients had pleural effusion, 5(11.36%) had abdominal TB, 5(11.36%) had tubercular meningitis, 4(9%) had intra thoracic lymphadenopathy and one (2.27%) patient had pericardial effusion. Low CD4 count (&lt;150) had statically significant association with HIV/TB co-infection.Conclusions: The prevalence of HIV-TB co-infection was high. Moreover, HIV positive patients need early diagnosis and treatment of active TB. The study has shown clear correlation between clinical data and the laboratory parameter of immunodeficiency (CD4 count) and the temporal development of TB.

Prevalence and Factors Associated with Tb-HIV Co-Infection among Tuberculosis Patients Treated at Specialist Hospital, Sokoto State, Nigeria 2014- 2017

Prevalence and Factors Associated with Tb-HIV Co-Infection among Tuberculosis Patients Treated at Specialist Hospital, Sokoto State, Nigeria 2014- 2017

Tuberculosis treatment outcome: The case of women in Ethiopia and China, ten-years retrospective cohort study.

Every year tuberculosis kills above half million women all over the world. Nonetheless, the factor affecting TB treatment outcome of women was less frequently studied and compared among countries. Hence, this study was aimed to measure and compare outcome of treatment and the death size of these two countries. Socio demographic and clinical data of women treated for all form of tuberculosis in the past ten years 2007-2016 were collected from total of eight hospitals and six treatment centers of Tigray and Zigong respectively. Then, we measured the magnitude of TB, level of treatment success and identify factors associated with the unsuccessful TB outcome. In the past ten years, a total of 5603(41.5%) and 4527 (24.5%) tuberculosis cases were observed in Tigray and Zigong respectively. Of those with treatment outcome record a total of 2602(92%) in Tigray and 3916(96.7%) in Zigong were successfully treated. Total of 170 (6%) cases in Tigray and 36(0.8%) cases in Zigong were dead. In Tigray, retreatment cases (aOR, 0.29; 95% CI: 0.16-0.53) and MDR-TB cases (aOR, 0.31; 95% CI: 0.003, 0.27) were less likely to show treatment success. However,, HIV co-infected TB cases (aOR, 3.58; 95% CI: 2.47, 5.18) were more likely to show treatment success compared with unknown HIV status. In Zigong, women with MDR TB (aOR, 0.90; 95%CI: 0.24, 0.34) were less likely to show treatment success and women in the age category of 15-49 (aOR, 1.55; 95% CI: 1.08, 2.206) were more likely to show treatment success. Big number of tuberculosis cases and death were observed in Tigray comparing with Zigong. Hence, a relevant measure should be considered to improve treatment outcome of women in Tigray regional state.

Genetic diversity of Mycobacterium tuberculosis clinical isolates from HIV-TB patients from two public hospitals at Bogotá, Colombia

The co-infection of TB/HIV is an increasing problem for public health worldwide. In Colombia, of 13.871 confirmed cases of TB in 2016 (prevalence of 0,028%) 14% correspond to HIV co-infection. However, we have scarce information regarding genetic diversity of strains infecting HIV patients. In this study, we carried-out an active search of cases of TB in 356 HIV-infected individuals, who were enrolled in two Public Hospitals at Bogotá-Colombia, between 2014 and 2015. We found 49 patients with HIV-TB co-infection. Genetic characterization of Mycobacterium tuberculosis (Mtb) isolates from these patients showed a predominance of three major sub-lineages: Haarlem (n = 26), LAM (n = 12) and T (n = 11). Remarkably, the most predominant pattern in the present study (SIT62/H1, n = 11) is very specific to this country. Indeed, taking in account distribution in countries with at least 3% of SIT62/H1, 36% of all such patterns collected worldwide were from Colombia. Furthermore, Colombia alone is responsible for almost all the SIT62/H1 strains in South America, suggesting a successful transmission of this genotype inside TB/HIV population from Colombia.

Prevalence of psychological distress and associated factors among adult tuberculosis patients attending public health institutions in Dire Dawa and Harar cities, Eastern Ethiopia

BackgroundIn developing countries, the prevalence of psychological distress was higher among tuberculosis patients. Patients with tuberculosis infection were more prone to psychological distress than peoples without tuberculosis. However, little studies were conducted on psychological distress among tuberculosis patients in Ethiopia, particularly in the Eastern Ethiopian health institutions.MethodsInstitution-based cross-sectional study design was conducted. Based on the TB burden, four hospitals and six health centers were selected from Dire Dawa and Harar cities. Socio-demographic factors, psychological distress, TB related stigma experience, and alcohol use data were collected by face to face interview while TB and HIV related variables collected from TB registration book. All TB patients from the first month of TB treatment initiation through 6 were consecutively interviewed by trained data collectors from January to February 2018. The collected data were entered into Epi Data Version 3.1 software and exported into SPSS window version 20 for analysis. Bivariate and multivariate binary logistic regression was carried out. All variables with P-value ≤0.25 were taken into the multivariate model. Crude and adjusted odds ratios with a 95% confidence interval were estimated, and variables with P-value less than 0.05 in the final model were taken as significant predictors of psychological distress.ResultsThe prevalence of psychological distress among tuberculosis in this study population was 63.3% (95% CI: 58.1, 68.1). Being from rural residence (AOR: 1. 98; 95% CI: 1.01,3.86), co-infection TB- HIV (AOR: 2.15; 95% CI:1.02, 4.56), presence of at least one chronic disease (AOR:3.04; 95% CI:1.59,5.79), experience of stigma (AOR: 1.71; 95% CI:1.01, 2.90), Pulmonary and MDR-TB (AOR:2.53; 95% CI:1.50,4.28) and smoking cigarette (AOR:2.53; 95% CI:1.06,6.03) were associated with psychological distress.ConclusionsIn this study, almost two-thirds of the tuberculosis patients had psychological distress. Chronic disease morbidity, HIV-TB co-infection and experienced TB related stigma were associated with psychological distress. Attention should be given to chronic diseases including HIV/AIDS diagnosis and referring to chronic disease units to prevent the impact on mental health. Consideration should be given for psychological distress and linking moderate to severe form of the disease to the Psychiatric clinics to hinder its effects.

Bayesian modeling of spatiotemporal patterns of TB-HIV co-infection risk in Kenya

BackgroundTuberculosis (TB) and Human Immunodeficiency Virus (HIV) diseases are globally acknowledged as a public health challenge that exhibits adverse bidirectional relations due to the co-epidemic overlap. To understand the co-infection burden we used the case notification data to generate spatiotemporal maps that described the distribution and exposure hypotheses for further epidemiologic investigations in areas with unusual case notification levels.MethodsWe analyzed the TB and TB-HIV case notification data from the Kenya national TB control program aggregated for forty-seven counties over a seven-year period (2012–2018). Using spatiotemporal poisson regression models within the Integrated Nested Laplace Approach (INLA) paradygm, we modeled the risk of TB-HIV co-infection. Six competing models with varying space-time formulations were compared to determine the best fit model. We then assessed the geographic patterns and temporal trends of coinfection risk by mapping the posterior marginal from the best fit model.ResultsOf the total 608,312 TB case notifications, 194,129 were HIV co-infected. The proportion of TB-HIV co-infection was higher in females (39.7%) than in males (27.0%). A significant share of the co-infection was among adults aged 35 to 44 years (46.7%) and 45 to 54 years (42.1%). Based on the Bayesian Defiance Information (DIC) and the effective number of parameters (pD) comparisons, the spatiotemporal model allowing space-time interaction was the best in explaining the geographical variations in TB-HIV coinfection. The model results suggested that the risk of TB-HIV coinfection was influenced by infrastructure index (Relative risk (RR) = 5.75, Credible Interval (Cr.I) = (1.65, 19.89)) and gender ratio (RR = 5.81e−04, Cr. I = (1.06e−04, 3.18e−03). The lowest and highest temporal relative risks were in the years 2016 at 0.9 and 2012 at 1.07 respectively. The spatial pattern presented an increased co-infection risk in a number of counties. For the spatiotemporal interaction, only a few counties had a relative risk greater than 1 that varied in different years.ConclusionsWe identified elevated risk areas for TB/HIV co-infection and fluctuating temporal trends which could be because of improved TB case detection or surveillance bias caused by spatial heterogeneity in the co-infection dynamics. Focused interventions and continuous TB-HIV surveillance will ensure adequate resource allocation and significant reduction of HIV burden amongst TB patients.

370. Comparing Trends and Outcomes among HIV-Infected vs. HIV Uninfected Patients with Tuberculosis: A 5-Year Experience Within the Florida Department of Health in Hillsborough County

BackgroundAlthough the rate of tuberculosis (TB) has significantly declined in the United States, elimination has plateaued. Florida is one of the states with the greatest number of cases. The majority of cases occur in foreign-born individuals. Human immunodeficiency virus (HIV) is also a major contributor. HIV-TB coinfection leads to reciprocal interactions with significant clinical impact. We aim to compare the risk factors, clinical findings, and outcomes among HIV-infected vs. HIV uninfected patients.MethodsA retrospective cohort study of TB cases over a 5 year period (2012–2017) was conducted. All patients with HIV co-infection with age- and gender-matched HIV negative controls were included. The diagnosis of TB was made via clinical, microbiological, radiological, and/or PCR based methods. SPSS was used for statistical data analysis.ResultsA total of 411 TB cases were identified and 66 patients (33 HIV-infected plus 33 HIV un-infected) were eligible for inclusion. The median age was 49 years (range 22–70). The male to female ratio was 21:12 and 50% of patients had TB symptoms; the rest had abnormal imaging or lab finding. Cases were confirmed via positive sputum smear, culture, or PCR (Figures 1–3). Only 11 patients were lost to follow-up, thus 83.3% completed therapy. A total of 5 persons died (Table 1).ConclusionThe rate of HIV-TB coinfection in the United States was 5.3% in 2018; higher among injection drugs users, homeless persons, inmates, and alcoholics. In our study, the rate of HIV-TB coinfection was slightly higher (8%). The difference was not statistically significant in regards to foreign born, homelessness, and incarceration. Only 3 patients admitted to injection drug use and 9 used alcohol (all HIV negative). Traditionally, HIV-TB coinfected patients have extra-pulmonary TB with higher rates of negative sputum and are at increased risk of death. In our cohort, the difference was statistically significant (P = 0.009) only for cavitary TB (predominated in HIV un-infected) but no difference in outcomes was observed between the two groups. These findings suggest changing trends in HIV-TB coinfection which may be partly related to our setting and demographics but may be attributed to better access to care and antiretroviral therapy at large. Disclosures All authors: No reported disclosures.

1342. Impact of HIV Infection on Treatment Outcome of New Tuberculosis Patients Attending Tuberculosis and Antiretroviral Treatment Services in the Community-Based Hospital, Thailand: A Retrospective Cohort Study

BackgroundTuberculosis (TB) and HIV are one of the significant public health problems in Thailand, and an estimated 15,000 individuals have a dual infection. Both HIV and TB each disease speeds up the progression of each other. TB is the leading cause of death in HIV-infected individuals, and HIV coinfected TB patients have disease-specific, and treatment affected their treatment outcomes. There is insufficient evidence on issues of TB and HIV co-infection patients received treatment. This study aimed to assess the impact of HIV status on treatment outcome of TB patients.MethodsWe conducted a retrospective cohort study among TB patients who registered to service at Chaophraya Abhaibhubejhr Hospital, Prachin Buri, Thailand from October 1, 2017 to October 31, 2018. All patients’ demographic data, diagnosis, and treatment were retrieved. Clinical characteristics, treatment outcome, and factors associated with treatment outcome were analyzed.ResultsThere were 49 (10.65%) HIV among 460 TB patients with a median (IQR) age of 44 (32–61) years old and 65.2% were males. Disseminated TB and extrapulmonary TB were higher in HIV coinfected group (P < 0.001). All pulmonary TB patients’ lower lobe involvement was higher in HIV coinfected group (62.50 vs. 36.00, P = 0.001). In HIV coinfected group median CD4 was 134 cell/mm3 (IQR 19–294), 66.67% were diagnosed HIV infection after TB diagnosis, the median time from TB diagnosed to antiretroviral was 29 days (IQR 21–48). The overall treatment success rate was 93.04%; the treatment success rate was similar in HIV coinfected TB patients (89.80%) and non- HIV-infected patients (93.43%) (P = 0.66).Adverse drug reactions were higher in HIV coinfected group (44.89% vs 12.41%) (P < 0.001). By multiple stepwise logistic regression, factors associated with anti-TB drug adverse reactions were having HIV infection (OR 7.99; 95% CI 3.73–17.10, P < 0.001), Age >60 years (OR 2.64; 95% CI 1.43–4.87, P = 0.002) and female sex (OR 1.97; 95% CI 1.11–3.52, P = 0.02).ConclusionThere is a high TB treatment success rate among patients who have treated for TB, but adverse drug events in HIV co-infected TB patients is higher than that observed in non-HIV-infected patients. Disclosures All authors: No reported disclosures.

1371. Tuberculosis and HIV Coinfection in the Bahamas: A Retrospective Review of Cases Diagnosed Between 2014 and 2016

BackgroundTuberculosis (TB) is one of the oldest diseases known to man, yet the world health organization reports that TB is one of the top 10 causes of death worldwide. HIV infection is the most potent biologic risk factor for developing tuberculosis. The HIV epidemic has been responsible for increasing the burden of TB worldwide and The Bahamas has been no exception. The aim of this study was to determine the HIV testing rate as well as prevalence of TB-HIV coinfection for The Bahamas and compare cases of TB based on HIV status for clinical presentation, radiologic findings, TST results and Smear and Culture results. We also evaluated cases of TB-HIV for degree of immunosuppression and compliance to antiretroviral therapy.MethodsA retrospective chart review of cases of Tuberculosis diagnosed at the Princess Margaret Hospital, Nassau, Bahamas. 189 cases of active tuberculosis diagnosed between 2014 and 2016 and all cases were evaluated for demographics, risk factors, HIV status, clinical manifestation, radiologic findings, and smear and culture results.ResultsOf the 189 cases of notified tuberculosis between 2014 and 2016, 109 (59.9%) were HIV negative and 73 (40.1%) were HIV positive. For patients who were HIV positive, 54(74%) were previously diagnosed with HIV and 19(26%) were newly diagnosed. Of the patients who were previously diagnosed with HIV, 14(25.9%) were on antiretroviral (ARV) medications and compliant, 34(63.0%) were on ARVs and noncompliant and 6(11.1%) were not on ARVs. 4(8.2%) patient had a CD4 count ≥500, 8(16.3%) patients had a CD4 count between 499–200 and 37(75.5%) had a CD4 counts 1000.ConclusionHIV is a major risk factor for Tuberculosis in the Bahamas and it is advised that all patients diagnosed with TB be tested for HIV. Routine screening of HIV patients for TB is recommended. Noncompliance with antiretroviral therapy remains a public health issue as it increases susceptibility to TB infection. Disclosures All authors: No reported disclosures.

Tuberculosis and HIV co-infection in inpatients of phthisio-pulmonological profile: frequency, form of lesion, diagnostic features (according to data of highly specialized institution)

Objective — to clarify the prevalence of tuberculosis infection in HIV-positive inpatients of the TB hospital for 2014—2018 and features of its diagnosis in the affection of the chest cavity organs.Materials and methods. The method of retrospective analysis was used to process medical records of the Institute’s clinic for the period 2014—2018. A database has been formed that includes all patients with HIV infection treated in the hospital, from which a group of patients with a final clinical diagnosis of co-infection tuberculosis and HIV was subsequently selected.Among them were 195 (68.9 %) men and 88 (31.1 %) women. The average age of men was (37.0 ± 0.5), women — (38.0 ± 1.2) years. Separate subgroups of patients were selected, taking into account the localization of the tuberculous process in the chest cavity. The general clinical data of patients, the presence of comorbidities, diagnostic methods, localization and prevalence of the tuberculous process were taken into account.Results and discussion. Among 496 hospitalized HIV-positive patients with various pathologies of the chest cavity, the diagnosis of tuberculosis, that is, the presence of HIV-TB co-infection, was established in 283 (57.1 %) cases. In 46 (16.3 %) cases the diagnosis of HIV infection was established for the first time during hospitalization. Comorbid pathology was present in 184 (65.0 %) patients.Specific lung damage prevailed, 123 (44 %) cases, most often infiltrative tuberculosis (48.8 %). In 33 % of cases, there was a widespread tuberculous lesion — pulmonary and extrapulmonary (pleura or lymph nodes were involved). Isolated pleural lesion was diagnosed in 13 % of cases. The main methods of laboratory diagnostics were classical bacteriological methods — simple direct light microscopy and MBT culture, the positive results of which were obtained in only half of all studies, as well as molecular-genotypic tests. Prevalence of multidrug-resistant MBT strains was found (66.7 %).In about half of the cases, (44.9 %), additional mini-invasive procedures or surgical interventions with therapeutic and diagnostic purposes were performed. Histological examination confirmed the diagnosis of tuberculosis in 92 % of cases, whereas in the absence of signs of tuberculosis, diagnoses of other opportunistic diseases were most often specified/established.Conclusions. In HIV-positive inpatients of a phthisiopulmonary profile, tuberculosis infection prevails in the structure of opportunistic morbidity, 57.1 %. The largest proportion of patients consist cases with pulmonary tuberculosis (44 %), is also a large group (33 %), formed by patients with the extended lesion of the organs of the chest cavity.Positive results of traditional bacteriological studies were obtained in approximately half of the cases, which required an expansion of the diagnostic algorithm with the implementation of mini-invasive diagnostic procedures with biopsy of the affected tissues and subsequent histological examination.Analysis of the results of laboratory diagnostics of tuberculosis in cases of TB/HIV co-infection showed that the use of not only different microbiological research methods is most effective, but an important component in the diagnostic search is the histological examination of biopsy material.