HIV-TB Co-infection Research Articles

Tuberculosis and HIV co-infection among miners at selected mining sites in Migori County, Kenya

Tuberculosis (TB) disease is caused by acid-fast bacilli called Mycobacterium tuberculosis. The emergence of drug-resistant TB variants as well as co-infection with the Human Immunodeficiency Virus (HIV) have complicated treatment for TB. Kenya currently implements TB screening and HIV testing for all patients and their caretakers, regardless of their reason for visiting the hospitals. Drug resistance is tested in all HIV-positive TB suspects to guide the choice of drugs in cases of TB-HIV co-infection and minimise delays in treatment initiation. These services are, however, confined to the health facilities, and all those who do not visit the hospitals are missed. The objective of our study was to evaluate TB missed opportunities among the mining community of Osiri-Matanda gold mines in Nyatike sub-county, Migori County, Kenya. Community health outreaches were conducted in collaboration with the Ministry of Health. Demographic information was recorded for all clients consenting to the study. HIV testing was done using the HIV rapid testing kits. Sputum samples were tested in the local laboratory using Ziel-Neelsen (ZN) staining. All TB-positive outcomes were further tested using GeneXpert MTB/RIF to determine whether or not they were resistant to Rifampicin. A total of 297 participants were enrolled in the study. Among these, 49.5% were males and 50.5% were females. The youngest participant was 15 years old, while the oldest was 63 years old. A 15.5% TB prevalence was found after testing, with the age range of 35–44 having the highest prevalence at 39%. 71.7% of TB infections were male, while 28.3% were female. HIV-TB co-infections accounted for 37% of cases. None of the TB cases were RIF-resistant. This data shows that males are more at risk of TB and HIV infections than females. Collaborative health outreaches that include screening and testing for both TB and HIV could help in early detection and minimise missed opportunities.

An Insight Into Tuberculosis Patients in the Chest Clinic of North India: Epidemiological Profile and Treatment Outcomes in the Wake of COVID-19.

Objectives Our study aims to re-evaluate the epidemiological profile and treatment outcomes of TB patients enrolled at the chest clinic of a tertiary care center after the third wave of COVID-19 in New Delhi. Patients and methods We have conducted an observational analytical study after taking the IEC approval from October 2022 to February 2022 on the TB patients enrolled from March 2022 to August 2022. The total data of 1114 TB patients was analyzed. The association between various factors and treatment outcomes was assessed using the chi-square test. To identify the independent effects of these factors on treatment outcomes, we did a multiple logistic regression analysis. Results We found that the treatment outcomes were mostly successful (83.9%, n=935), while a few patients lost to follow-up (11.7%, n=130) and died (4.4%, n=49). Deaths were significantly higher among geriatrics (19%, n=15), PTB (4.9%, n=30), and MDR TB (15%, n=3). The treatment success was highest among the new category of patients (85.1%, n=807), followed by retreatment patients (80.1%, n=117) and MDR TB patients (55%, n=11). Adults and geriatrics had a significantly higher risk of death (4.45 times and 27.93 times, respectively) compared to pediatrics. In addition, death risks were higher among males (1.6 times for females), MDR TB patients (17 times for new patients), and HIV-reactive patients (3.05 times for HIV non-reactive patients). Conclusion We found that males, HIV-TB co-infection, the geriatric population, pulmonary TB patients, and MDR TB were at a higher risk of death. By identifying high-risk groups, policymakers can prioritize targeted interventions and allocate resources effectively to address the specific needs of these vulnerable populations.

Modeling Transmission Dynamics of Tuberculosis-HIV Co-Infection in South Africa.

South Africa has the highest number of people living with the human immunodeficiency virus (HIV) in the world, accounting for nearly one in five people living with HIV globally. As of 2021, 8 million people in South Africa were infected with HIV, which is 13% of the country's total population. Approximately 450,000 people in the country develop tuberculosis (TB) disease every year, and 270,000 of those are HIV positive. This suggests that being HIV positive significantly increases one's susceptibility to TB, accelerating the spread of the epidemic. To better understand the disease burden at the population level, a Susceptible-Infected-Recovered-Dead (SIRD) TB-HIV co-infection epidemic model is presented. Parameter values are estimated using the method of moments. The disease-free equilibrium and basic reproduction number of the model are also obtained. Finally, numeric simulations are carried out for a 30-year period to give insights into the transmission dynamics of the co-infection.

Viral Load and CD4+ Markers as Determinants of Tuberculosis Coinfection Among People Living with HIV/AIDS in Papua Indonesia.

Tuberculosis (TB) infection causes mortality among People Living with HIV (PLHIV), so the treatment of TB-HIV coinfection is crucial. The study aimed to identify the determinants contributing to TB coinfection among PLHIV in Papua. It is a descriptive-analytic study with a cross-sectional design involving 188 PLHIV at the four hospitals in Papua. CD4+ was carried out using CD4+ counter and viral load using the qPCR technique. A logistic regression test and R statistic with a significance level of 0.05 were used to analyze the determinants of TB coinfection among PLHIV. PLHIV having CD4+ count of fewer than 350 cells/mm3 had a 17.8 times higher risk for TB-HIV coinfection, P-value = 0.0. In addition, a viral load of more than 10 000 copies/ml will be 12.1 times more likely to be co-infected with TB-HIV compared to those who have a viral load of fewer than 10 000 copies/ml, P-value = 0.0. CD4+ markers and viral load are factors that play a role in TB coinfection among PLHIV in Papua Province.

Serum Interferon Gamma (IFN-ɣ) Levels and Hematological Indices in Patients with HIV-MTB Co-Infection in North-Eastern Nigeria

Introduction: The dual epidemic of human immunodeficiency virus (HIV) infection and Mycobacterium tuberculosis (MTB) poses significant health challenges, particularly in sub-Saharan Africa. Understanding the immune response and hematological changes in HIV-MTB co-infection is crucial for better management of affected individuals. Objectives: This study aimed to evaluate the serum levels of IFN-ɣ and hematological indices in patients with HIV-MTB co-infection in North-Eastern Nigeria, as well as explore any potential relationships between these factors. Methods: A total of 88 participants were enrolled in the study, including 44 antiretroviral therapy-naive patients with HIV-MTB co-infection (study group) and 44 HIV mono-infected individuals as controls. Data on personal biodata and clinical details were collected using an interviewer-administered questionnaire. Blood samples were obtained from each participant and analyzed for IFN-ɣ levels using ELISA and hematological indices using an automated hematology analyzer. Statistical analysis, including Mann-Whitney U test, independent samples t-test, and Pearson's correlation analysis, was conducted to compare the study and control groups and assess the relationship between IFN-ɣ levels and hematological parameters. Results: Serum IFN-ɣ was insignificantly increased in the study group compared to the control group (p=0.093). The WBC count was also significantly reduced in the study group compared to the control group (p=0.038). The HGB, HCT, MCV and MCH were significantly reduced in the study group compared to the control group (p=0.001, 0.001, 0.002 and 0.001) respectively. Participants with HIV-TB co-infection have insignificantly increased serum IFN-ɣ levels, low total WBC, lymphocyte and monocyte counts compared to those with HIV mono-infection. In conclusion, participants with HIV-TB co-infection have insignificant increased serum IFN-ɣ levels, low total WBC, and lymphocyte and monocyte counts compared to those with HIV mono-infection. There was no correlation of IFN-ɣ with any of the haematological indices.

Impact of human immunodeficiency virus on category I pulmonary tuberculosis cases in a tertiary care hospital: a case control study

Background: Tuberculosis (TB) is an opportunistic infection (OI). OIs are infections that occur more often or are more severe in people with weakened immune systems than in people with healthy immune systems. Human immunodeficiency virus (HIV) weakens the immune system, increasing the risk of TB in people with HIV. This case control study was done to assess the impact of HIV on clinical aspects and treatment outcome of newly diagnosed bacteriologically positive pulmonary tuberculosis. Methods: This study was done among unmatched 75 cases and 75 controls who were pulmonary TB and TBHIV co-infected patients. Data were collected using a pretested, structured, interviewer-administered questionnaire and was analyzed using descriptive and analytical statistics. Results: Total 150 patients were enrolled in the study out of which 75 patients had HIV-TB co-infection while remaining 75 patients were diagnosed as pulmonary TB. Treatment success rates are 74.7 % (56/75) for TB-HIV co-infected patients and 82.7% (62/75) for pulmonary TB patients. TB-HIV co-infected patients had a higher risk of an unsuccessful treatment outcome [(p = 0.232) with OR and 95% CI of 0.68 (0.28-1.36)]. The risk of unsuccessful treatment outcome was associated with family history of TB, Tobacco use, low BMI. Conclusions: TB treatment success rate is good as compared to the WHO minimum requirement. Successful treatment outcome is lower among patients with HIV infection, tobacco use, low BMI, <200 /mm3 CD4 count patients. Therefore, due emphasis should be given to these high-risk groups.

Pulmonary tuberculosis case notification and burden of drug resistance among children under 15 years of age in Ethiopia: sub-analysis from third-round drug resistance tuberculosis survey

IntroductionData on the burden of bacteriologically confirmed childhood Tuberculosis (PTB) and drug-resistant TB in Ethiopia is limited due to difficulties related to its diagnosis in this population. Therefore, this study aimed to assess bacteriologically confirmed childhood PTB Case Notification Rates (CNRs) and the burden of Drug Resistant-Tuberculosis among children in Ethiopia.MethodRetrospective secondary clinical and laboratory data were obtained from 3rd round national DR-TB survey which was conducted between August 2017 and January 2019. We used IBM SPSS 24 for sub-analysis of 3rd round Drug Resistant-Tuberculosis data. Descriptive statistics were used in computing the association between the sociodemographic characteristics and PTB CNRs, and the strength of the associations was determined using binary logistic regression with Odds ratios (OR) with a 95% confidence interval (CI).ResultOverall, 102 bacteriologically confirmed childhood PTB cases were identified with a median age of 12 (range 1–14) years. Of these, 54 (52.9%) were females and 81 (79.4%) lived in rural areas. HIV-TB co-infection cases were 5/102 (4.3%) and the majority (98%) of cases were newly diagnosed children. Nationally, the incidence of bacteriologically confirmed childhood PTB was calculated to be 5.1 per 100,000 children. The burden of Drug Resistant-Tuberculosis to at least one of the five first-line anti-TB drugs tested was five (6.5%) cases and one (1.3%) was found to be a Multi-drug resistant tuberculosis case. Drug-resistant tuberculosis was significantly associated with the age group 10–14 years (P = 0.002; [AOR] 29.76; [95% CI, 3.51-252.64]) and children living in urban areas (P = 0.027; [AOR] 5.76; 95% CI, 1.22–27.09).ConclusionBacteriologically confirmed childhood PTB cases increased as the age of the children increased. Most of the bacteriologically confirmed childhood PTB and the identified drug Resistant-Tuberculosis cases were new cases. Also, rural children were more affected by TB than their urban, counterparts Drug Resistant-Tuberculosis was higher in urban resident children.

Treatment outcomes and associated factors among tuberculosis patients attending Gurage Zone Public Hospital, Southern Nations, Nationalities, and People's Region, Ethiopia: an institution-based cross-sectional study.

Tuberculosis remains the most important global health problem. Worldwide, tuberculosis is the cause of a single infectious agent and the ninth leading cause of death, ranking above human immunodeficiency virus. In high-burden settings, one of the mechanisms to control tuberculosis is to identify patients' problems during treatment. Nevertheless, the problem is still a countrywide issue, and there is a shortage of research to show treatment outcomes and associated factors of tuberculosis in Southern Nations, Nationalities, and People's Regions in the Gurage Zone. An institution-based, cross-sectional study was conducted to collect data from 347 medical records of tuberculosis patients from 20 July 2016 to 30 July 2021 at Gurage Zone Public Hospitals. The tool includes data about socio-demographic characteristics, as well as tuberculosis-related, and tuberculosis treatment outcome status. Data were analyzed using SPSS version 26, and multivariable logistic regression analyses were conducted to identify significantly associated variables with successful tuberculosis treatment outcomes. The adjusted odds ratio (AOR) with its 95% confidence interval (CI) at a p-value of < 0.05 was used to claim statistical association. In this study, the overall prevalence of successful tuberculosis treatment outcomes was 79.3%. HIV-negative tuberculosis patients (AOR = 4.33; 95% CI: 1.91, 9.79), patients aged < 20 years (AOR = 0.16; 95% CI: 0.04, 0.74), and married participants (AOR = 0.29; 95% CI: 0.10, 0.88) were significantly associated with successful tuberculosis treatment outcomes. The prevalence of successful tuberculosis treatment outcomes was low. HIV-TB co-infection, single marital status, and age >20 years negatively affected the treatment outcomes of tuberculosis, thus more effort and better attention should be given to better outcomes of tuberculosis patients, especially for HIV-TB co-infected participants.

Prevalence of Hepatitis B Virus, Human Immune Deficiency Virus and Associated Risk Factors Among Individuals with Presumptive Pulmonary Tuberculosis Attending at Saint Peter's Specialized Hospital, Addis Ababa, Ethiopia.

Hepatitis B virus (HBV), human immunodeficiency virus (HIV) and tuberculosis are the causes of widely spread infectious disease, especially in resource-limited countries. The extent of HBV infection and its contributing factors among people with suspected pulmonary tuberculosis (PTB) were not adequately addressed. To assess the prevalence of HBV, HIV & their associated risk factors and the magnitude of TB among individuals with presumptive pulmonary tuberculosis attending at St. Peter's Specialized Hospital, Addis Ababa, Ethiopia. A cross-sectional study was conducted among 387 individuals with presumptive PTB from October to December 2020. A standard questionnaire was used to collect socio-demographic data and associated risk factors. Sputum samples were analyzed by GeneXpert, Florescent Microscopy and Ziehl-Nelson staining technique. HBsAg test was carried out using Murex Version 3 ELISA test kit from serum/Plasma samples,HIV testing was performed by rapid HIV test kits and data were analyzed using SPSS version 23. The mean age of study participants was 44.2 years. Overall, 14 (3.6%), 28 (7.2%) and 37 (9.6%) of them were positive for HBV, HIV & TB, respectively. Only single patient was HBV-HIV co-infected (0.3%). The TB-HIV co-infection was identified in 6 (1.6%). In multivariate analysis, being partner separated, alcohol consumption, body piercing and having multiple sexual partners were significantly associated with HBV infection. Having a spouse, who is divorced, widowed, sharing scissors, alcohol consumption and contact with multiple sexual partners also significantly associated with HIV infection. This study showed that HBV, HIV and TB are still public health issues that need awareness and health education on the risky behaviors and transmission of HBV, HIV & TB among individuals with presumptive TB suspects. Further large-scale study is necessary.

Burden of Pulmonary Rifampicin-Resistant Tuberculosis in Kajiado, Kenya: An Observational Study.

Rifampicin resistance (RR) is a major challenge in the clinical management of tuberculosis (TB), but data on its prevalence are still sparse in many countries. Our study aimed at estimating the prevalence of RR-TB in Kajiado County, Kenya. Secondary objectives were to estimate the incidence of pulmonary TB in adults and the rate of HIV-TB coinfection. We conducted an observational study in the context of the ATI-TB Project, carried out in Kajiado. The project was based on an active-case-finding campaign implemented with the aid of village chiefs, traditional healers and community health volunteers. Diagnosis relied on Xpert MTB/RIF, including a mobile machine that could be used to cover areas where testing would otherwise be difficult. In sum, 3840 adults were screened for active TB during the campaign. RR cases among all TB diagnoses were 4.6%. The annual incidence of pulmonary TB among adults was 521 cases per 100,000 population. The rate of HIV coinfection was 22.2% among pulmonary TB diagnoses. The prevalence of RR-TB was four times that what could be inferred from official notifications in Kajiado, and higher than overall prevalence in Kenya. In addition, our estimate of incidence of pulmonary TB in adults in Kajiado significantly differed from cases notified in the same area. In contrast, the rate of HIV coinfection was in line with national and regional data. TB diagnostic capability must be strengthened in Kajiado to improve patients' management and public health interventions.

Tuberculosis Treatment Outcome and Associated Factors Among Tuberculosis Patients Linked to Tuberculosis Treatment Clinics in Ethiopia, 2023: A Multi-Center Retrospective Study.

Tuberculosis is a communicable disease, mainly caused by the bacillus Mycobacterium tuberculosis. Globally, TB is the ninth leading cause of death, with developing countries bearing most of the burden. The discovery of chemotherapy lead to significant improvements in patient survival. Therefore, this study aimed to assess Tuberculosis treatment outcomes and associated factors in South Gondar Administrative Zone Governmental Hospitals, Northwest Ethiopia, 2023. A hospital-based retrospective study was conducted from July 1 to August 30, 2022, at South Gondar zone public hospitals. The data was entered into Epi-data version 4 and exported to STATA version 14. A binary and multivariable logistic regression was computed at a 95% confidence interval. Variables with a p-value less than 0.25 in the bivariable analysis were chosen for multivariable logistic regression analysis, and variables having a p-value of less than 0.05 in the multivariable analysis, were considered to have significant associations with the dependent variable. The study included 400 tuberculosis patients, and the overall successful treatment outcome was 89.0% (95% Confidence Interval: 85.5-91.7). In this study, study participants who tested positive for HIV were approximately three times more likely to have unsuccessful treatment outcomes (Adjusted odds ratio = 3.07; 95% Confidence Interval = 1.49-6.16.5; P = 0.002) relative to HIV-negative patients. On the other hand, patients with sputum-positive were more likely to have a successful treatment rate (Adjusted odds ratio = 0.08; 95% Confidence Interval = 0.011-0.638, P = 0.002) relative to sputum-negative TB patients. The overall treatment success rate was 89.0%, which was lower than the global milestone target of > 90% set for 2025, and the prevalence of TB-HIV coinfection was 16.5%. In this study, HIV-positive was negatively associated with successful treatment outcomes, and sputum positive was independently associated with successful tuberculosis treatment outcomes.

A Review of the Development of Multitarget Molecules against HIV-TB Coinfection Pathogens.

The human immunodeficiency virus (HIV) produces the pathologic basis of acquired immunodeficiency syndrome (AIDS). An increase in the viral load in the body leads to a decline in the number of T lymphocytes, compromising the patient's immune system. Some opportunistic diseases may result, such as tuberculosis (TB), which is the most common in seropositive patients. Long-term treatment is required for HIV-TB coinfection, and cocktails of drugs for both diseases are used concomitantly. The most challenging aspects of treatment are the occurrence of drug interactions, overlapping toxicity, no adherence to treatment and cases of resistance. Recent approaches have involved using molecules that can act synergistically on two or more distinct targets. The development of multitarget molecules could overcome the disadvantages of the therapies used to treat HIV-TB coinfection. This report is the first review on using molecules with activities against HIV and Mycobacterium tuberculosis (MTB) for molecular hybridization and multitarget strategies. Here, we discuss the importance and development of multiple targets as a means of improving adherence to therapy in cases of the coexistence of these pathologies. In this context, several studies on the development of structural entities to treat HIV-TB simultaneously are discussed.

On the Optimal Control of HIV-TB Co-Infection and Improvement of Workplace Productivity

Human immunodeficiency virus (HIV) and tuberculosis (TB) have long been known to have a synergistic relationship. This is a result of each of the diseases impacting negatively on the immune system of the infected persons. The impact of these diseases on workforce productivity is studied in this paper from the viewpoint of dynamical systems. In this paper, we present a nonlinear ordinary differential equation model to study the dynamics of HIV-TB co-infection and its effect on workforce productivity. The main model is first decoupled into two basic submodels of HIV-only and TB-only models, whose qualitative properties are presented before the qualitative properties of the main model are studied. While the HIV-only model is shown to have a globally asymptotically stable disease-free equilibrium whenever its basic reproduction number is less than unity, the TB-only model is shown to exhibit backward bifurcation under some conditions. To investigate the impact of various intervention strategies on the control of the co-infection and improvement of workforce productivity, five time-dependent controls (involving transmission prevention for the two diseases, therapy for the two diseases, and capacity building for improved workforce productivity) are incorporated into the basic model to form an optimal control problem, which is qualitatively analyzed using Pontryagin’s maximum principle and numerically simulated. Incremental cost-effectiveness analysis is conducted with the results of the numerical simulations. It is observed that the most cost-effective strategy for fighting the spread of the co-infection with enhanced productivity is that of combining both preventative and curative measures along with skills training.

PROFILE OF TUBERCULOSIS PATIENTS IN PERSON LIVING WITH HIV (PLHIV) AND THEIR RELATIONSHIP WITH CD4 COUNTS

Background- This study aims to observe prole of TB in PLHIV patients and their correlation with CD4 counts. Methods- This is a crosssectional observation study done from January 2021 to June 2022 in department of respiratory medicine GMC Bhopal. PLHIV patients between 12-60 years of age with clinico-radiological and microbiological evidence of TB were included. Patients with history of TB treatment with currently no evidence of active TB and with any chronic ailments were excluded to avoid bias. Results- Out of 100 patients, 53 patients had only pulmonary TB, 18 patients had only EPTB and 29 patients had disseminated TB. Pleural effusion was the most common EPTB (31.9%). In this study HIV-TB coinfection is more prevalent in male (70%) with maximum 40 cases in 30-40 year age group. According to CD4 counts 68 patients were in CD4 counts &lt;200 cells/mm3. Most common clinical feature was cough (89%) followed by decrease appetite (88%), fever (85%), loss of weight (85%), expectoration (73%), dyspnea (46%) and night sweats (31%). Out of 100 cases, 31 cases detected by CBNAAT among which 16 cases also had positive sputum microscopy. Chest x-ray among 100 patients showed inltrates in 82 cases with maximum (70.7%) in CD4 counts&lt;200 cells/mm3.Also chest x-ray showed inltrates with cavity in 14 patients with maximum (71.4%) in CD4 counts &gt;500 cells/mm3. Conclusion- In this study, severity of clinical feature, radiological ndings, EPTB &amp; disseminated TB cases increase as CD4 counts decrease. Overall pulmonary TB is still more common presentation. Also microbiological diagnosis is poor in lower CD4 counts due to paucibacillary disease. Presentation of TB become more atypical as CD4 counts decreases. .We recommend that special attention has to be given to all patients with low CD4 counts as they are more prone to atypical features, EPTB &amp; disseminated TB.

Detection of Pulmonary Tuberculosis by Gene Xpert Method among HIV Patient in ART Center, Gadarif State, Sudan

Background: Tuberculosis (TB) is one of the most common and deadly infectious diseases in humans. Due to widespread poverty, inequity, and conflict, suboptimal health services in many countries, and the impact of the HIV/AIDS pandemic, TB/HIV co-infected patients frequently test negative for TB with direct microscopy, posing diagnostic challenges. Traditional HIV-associated TB diagnosis is complex, expensive, time-consuming, and technically demanding because it relies on conventional culture and drug susceptibility testing. The lengthy wait for results has disastrous consequences for patients who go undiagnosed or are diagnosed too late.&#x0D; Objective: To detect the accuracy of gene X pert® MTB/RIF as a novel automated molecular tool to diagnose Mycobacterium tuberculosis in HIV patients.&#x0D; Methods: A cross sectional study was conducted on 70 HIV patients suspected to have Mycobacterium tuberculosis and who were referred to the ART and Tuberculosis Centers at Gadarif state, from June 2022 to December 2022. Sputum samples were tested by two methods involved the Gene X pert (Cepheid, California, United States of America) and direct smear microscopy (SM) stained with ZN stain for detection of acid fast bacilli. Out of 70 sputum samples analyzed for acid fast bacilli, 50(71%) cases were positive using GeneXpert whereas the DM was positive only for 28 (4o %) of the cases. GeneXpert detected another 22 AFB positive cases. Therefore GeneXpert is more accurate. Sensitivity of the GeneXpert was calculated as 93% and the specificity was 43%. The majority of the patients who contributed to (SM) were found to be co-infected with HIV.&#x0D; Conclusion: GeneXpert demonstrated two-time case detection rate compared to the sputum smear microscopy so the direct smear showed poor performance tool for evaluation of TB-HIV co-infection. Also The Gene X pert’s sensitivity was found to be high while the specificity was low. Although this was the case, the GeneXpert as compared to DM could greatly reduce false negatives and the wait on treatment initiation can be significantly shortened, minimising premature death and continued transmission.

Spatial patterns of tuberculosis in Russia in the context of social determinants

Our study investigated the spatial distribution of tuberculosis and the influence of social determinants in Russia between 2006 and 2018 using the regional incidence of multi-drug resistance tuberculosis, HIV-TB coinfection, and mortality data. The “space-time cube” method identified the uneven geographical distribution of the tuberculosis burden. There is a clear distinction between a healthier European Russia, where a statistically significant stable trend towards a decrease in incidence and mortality was found, and the eastern part of the country, where there is no such trend. Generalized linear logistic regression analysis found that the challenging situation was associated with HIV-TB coinfection incidence, with a high incidence rate being detected even in more prosperous regions of European Russia. HIV-TB coinfection incidence was determined by a set of socioeconomic variables, out of which the influence of income and urbanization were the most pronounced. The influence of crime could indicate the spread of tuberculosis in socially disadvantaged regions.

Spatial Clustering of Tuberculosis-HIV Coinfection in Ethiopia at Districts Level.

Tuberculosis (TB) is a preventable and treatable disease but it is the leading cause of death among people living with HIV (PLHIV). In addition, the emergence of the HIV pandemic has also had a major impact on TB incidence rates. There are studies in spatial patterns of TB and HIV separately in Ethiopia; there is, however, no information on spatial patterns of TB-HIV coinfection in the country at the districts level at least using yearly data. This paper, therefore, aimed at determining the spatial clustering of TB-HIV coinfection prevalence rates in the country at the districts level on an annual basis over a four-year period, 2015-2018. District-level aggregated data on the number of TB-HIV infections were obtained from the Ethiopian Federal Ministry of Health for 2015 to 2018. The univariate and bivariate global Moran's index, Getis-Ord G i ∗ local statistic, a chi-square test, and a modified t-test statistic for Spearman's correlation coefficient were used to evaluate the spatial clustering and spatial heterogeneity of TB among PLHIV and HIV among TB patients prevalence rates. The district-level prevalence rate of HIV among TB patients was positively and significantly spatially autocorrelated with global Moran's I values range between 0.021 and 0.134 (p value <0.001); however, the prevalence of TB among PLHIV was significant only for 2015 and 2017 (p value <0.001). Spearman's correlation also shows there was a strong positive association between the two prevalence rates over the study period. The local indicators of spatial analysis using the Getis-Ord statistic revealed that hot-spots for TB among PLHIV and HIV among TB patients have appeared in districts of various regions and the two city administrations in the country over the study period; however, the geographical distribution of hotspots varies over the study period. Similar trends were also observed for the cold-spots except for 2017 and 2018 where there were no cold-spots for TB among PLHIV. The study presents detailed knowledge about the spatial clustering of TB-HIV coinfection in Ethiopia at the districts level, and the results could provide information for planning coordinated district-specific interventions to jointly control both diseases in Ethiopia.

Effectiveness of anti-tuberculosis drugs in tuberculosis and HIV co-infected patients coming to tertiary health-care center in South Gujarat

Background: Tuberculosis (TB) and human immunodeficiency virus (HIV) are major public health problems in most of the developing countries, including India. For developing TB, HIV infection is one of the strongest risk factors. The presentation and outcome of TB are affected by HIV infection. Aims and Objectives: The objective is to study the type of TB, level of CD4 count, TB presentation in TB-HIV patients. Observation of anti-TB treatment, adverse drug reactions (ADR), and outcome of anti-TB treatment in patients with TB-HIV co-infection. Materials and Methods: The present study is an observational, longitudinal, prospective, and single-center study of adult patients having TB-HIV co-infection. To evaluate the clinical course, outcome, and safety of anti-TB drugs, the selected patients were followed up during the study. Results: In our study, 59 patients of TB-HIV co-infection on anti-TB treatment were observed. About 61% of the patients were msale. Most of the patients had pulmonary TB (61%) and extra-pulmonary TB (EPTB) was found in 38.9% of patients. Tuberculous pleural effusion and cervical tuberculous lymphadenitis were the most common among EPTB cases. 93.2% of cases were drug-sensitive TB and 6.8% cases were drug-resistant TB. Low CD4 count &lt;200 cell/cu.mm were observed in 61% of patients. All patients were treated according to RNTCP and National AIDS Control Organization guidelines. Majority of cases (67.8%) had no ADR. The most common ADR observed were gastritis and GIT symptoms (15.3%). Successful treatment was observed in 41 patients (69.5%), and interim outcomes were observed in 2 patients (3.4%). Three patients (5.1%) were transfer out, 6 patients (10.2%) were lost to follow-up, 7 patients (11.9%) died. Among patients who had CD4 count &lt;200 cell/cu.mm, successfully treated patients were 61.1%, and among patients who had CD4 count ≥200 cell/cu.mm, 82.6% of patients were successfully treated. Conclusion: Pulmonary TB is common than EPTB. In most of the patients, anti-TB drugs are effective, also well tolerated with ADRs in few patients. Most of ADRs are non-serious. The success rate of treatment is more among patients who had CD4 count ≥200 cell/cu.mm than among patients who had CD4 count &lt;200 cell/cu.mm.

Tuberculosis and HIV coinfection and rifampicin-resistant tuberculosis among patients living with HIV in Northern part of West Bengal, India

Background: India is one of the top most country among the high tuberculosis (TB) burden countries and ranks the third highest human immunodeficiency virus (HIV) burden country in the world contributing to 23% of the total global load. Mycobacterium tuberculosis (MTB) and HIV are known to act synergistically and result in higher mortality rates. TB-HIV coinfection and emergence of drug resistant forms of MTB can impact positively on treatment outcomes. Aims and Objectives: The aim of this study was to determine of the prevalence of TB-HIV co-infection among MTB and to determine the prevalence of rifampicin (RIF) resistant TB among HIV seropositive patients. Materials and Methods: It was a retrospective and observational study carried out in the Department of Microbiology, Malda Medical College, Malda, West Bengal. Records of all patients that tested using CBNAAT during March 2016–December 2019 in the CBNAAT laboratory of Malda Medical College were assessed. Data generated during this period were collected and analyzed. The statistical analysis was done in tabulation form and different charts and tables were used for displaying data. Results: A total of 6503 samples were tested in CBNAAT laboratory during March 2016–December 2019. Out of 6503, 3098 samples were positive for CBNAAT (MTB detected).Of 3098 MTB, 8.91% (276/3098) were RIF resistant. Among 3098 MTB, 91.22% (2826/3098) were pulmonary TB (PTB) and 8.78% (272/3098) were extra PTB. Out of 6503 total samples, 664 were reported patients living with HIV. The prevalence of TB-HIV coinfection was 3.91% (121/3098) among MTB positive cases. Of all TB-HIV coinfected cases, most of the patients (67.77%) were in the age group of 20–39 years and males (77.69%) contributed to more than females. Of 121 TB-HIV coinfected, 88.43% (107/121) were sensitive to RIF and 11.57% (14/121) were resistant to RIF. Conclusion: The present study reported that the prevalence of TB-HIV coinfection was 3.91% and the prevalence of RIF resistant TB in HIV seropositive patients was higher than HIV seronegative patients. Thus, all TB patients should be screened for HIV and all HIV-positive individuals should be screened for TB along with drug resistance for better management.

Factors associated with post-mortem notification of tuberculosis cases in Brazil, 2014.

According to the World Health Organization (WHO), 1.6 million deaths and 10.6 million cases of tuberculosis (TB) were reported worldwide in 2021. If treated opportunely with the recommended therapy, 85% of patients with TB are healed. The occurrence of death from TB without prior notification of the disease indicates failure in the timely access to this effective treatment. Therefore, this study aimed to identify TB cases with post-mortem notification in Brazil. This is a nested case-control study using a cohort of new TB cases reported to the Braziliam Information System for Notificable Diseases (SINAN). This study analyzed the following variables: selected characteristics of the individual (gender, age, race/color, education), the municipality (Municipality Human Development Index - M-HDI, poverty rate, size, region, and municipality), health services, and underlying or associated cause of death. Logistic regression was estimated using a hierarchical analysis model. People with TB aged 60 years or older (OR = 1.43), with low educational level (OR = 1.67), and with malnutrition (OR = 5.54), living in municipalities with low M-HDI and medium population size (OR = 1.26), located in the North Region of Brazil (OR = 2.42) had a higher chance of post-mortem notification. Protective factors were HIV-TB coinfection (OR = 0.75), malignant neoplasms (OR = 0.62), and living in cities with broad primary care coverage (OR = 0.79). Vulnerable populations should be prioritized in order to address the obstacles to the access to TB diagnosis and treatment in Brazil.