Tuberculosis Co-infected Patients Research Articles

Treatment Outcomes of Tuberculosis and Associated Factors Among Tuberculosis and Human Immunodeficiency Virus Co-infected Patients in Public Health Facilities in Jigjiga, Somali Region, Ethiopia.

Worldwide, tuberculosis (TB) is a serious public health issue, especially in low-income countries, including Ethiopia. For those who are HIV-positive, TB poses a major risk to their health. The development of chemotherapy and the effectiveness of treatment have resulted in notable increases in patient survival. The evaluation of TB treatment outcomes is an essential metric for determining the success of TB and HIV co-morbidity control strategies. This study aims to identify TB treatment outcomes and associated factors among TB/HIV co-infected patients in public health facilities in Jigjiga, Somali Region, Ethiopia, in 2021. A hospital-based cross-sectional study design was done on three facilities (Karamara, Hasan Yabare Referral Hospital, and Jigjiga Health Center) with a total of 194 study participants. Data were extracted using a checklist, entered into EpiData version 3 (The EpiData Association, Odense, Denmark), and analyzed using SPSS Statistics version 20 (IBM Corp. Released 2011. IBM SPSS Statistics for Windows, Version 20.0. Armonk, NY: IBM Corp.) for descriptive and inferential analysis of the study objectives. Variables in the bivariate logistic regression analysis with p-values less than 0.25 were entered into a multivariate logistic regression to identify the independent factors of TB treatment outcome. Associations were computed using an adjusted odds ratio with a 95% CI. P-values less than 0.05 were finally considered statistically significant. The following TB treatment outcomes were observed among all TB/HIV co-infected patients enrolled in this study: 126 (67.4%) completed treatment, three (1.8%) died, 42 (22.5%) were cured, and 16 (8.6%) were transferred out; 168 (89.8%) had a successful treatment outcome. Category of the patient (AOR = 0.194, 95% CI: 0.041, 0.923), sex of the patient (AOR = 1.490, 95% CI: 1.449, 4.951), and cotrimoxazole preventive therapy (CPT) initiation (AOR = 0.073, 95% CI: 0.021, 0.254) were found to be significant predictors for successful TB treatment outcome at a p-value less than 0.05 with a 95% CI. Overall, 89.8% of TB treatments were successful among TB/HIV co-infected patients. This study has found sex, socioeconomic status, and CPT initiation were significant factors for a successful TB treatment outcome. Based on these findings, governmental and non-governmental organizations should facilitate the implementation and enforce the availability of all TB/HIV co-infected patients.

Paradoxical tuberculosis-associated immune reconstitution inflammatory syndrome in initiating ART among HIV-Infected patients in China-risk factors and management

BackgroundChina is a country burdened with a high incidence of both tuberculosis (TB) and HIV, Paradoxical tuberculosis-associated immune reconstitution inflammatory syndrome (TB-IRIS) is an important early complication in TB and HIV co-infected patients, but data from China are limited. Additionally, as an integrase strand transfer inhibitor (INSTI)-based antiretroviral therapy (ART) regimen becomes the first-line treatment, concerns have arisen regarding the potential increase in the incidence of paradoxical TB-IRIS. Nevertheless, the existing data are inconclusive and contradictory.MethodsWe conducted a retrospective study at Chongqing Public Health Clinical Center from January 2018 to December 2021. We collected demographic and clinical data of HIV/TB co-infected patients who initiated ART. We described the patient characteristics, identified predictors for TB-IRIS, and determined clinical outcomes. The Statistical Package for Social Science (SPSS 25) was used to analyse the data. Continuous variables were compared using Student’s t-test or rank sum test. Counting data were compared using the chi-square test or Fisher’s exact test. The variables with statistical significance in the univariate analysis were added to the binary logistic regression. A p-value less than 0.05 was considered statistically significant.ResultsA total of 384 patients co-infected with naive HIV and pulmonary TB (PTB) who were given ATT and ART combination were included. 72 patients (18.8%) developed paradoxical TB-IRIS with a median of 15 (12, 21) days after initiating ART. Baseline age ≤ 40years, CD4 + T-cell counts ≤ 50cells/µL, HIV viral load ≥ 500,000 copies/mL were found to be significantly associated with development of paradoxical TB-IRIS. Mortality rates were similar in the TB-IRIS (n = 5, 6.9%) group and non-TB-IRIS (n = 13, 4.2%) group. Interestingly, CD4+ T-cell counts recovery post-ART was significant higher in the TB-IRIS group when compared to the non-TB-IRIS group at the end of 24 weeks (P = 0.004), as well as at 48 weeks (P = 0.015). In addition, we consider that INSTI- based ART regimen do not increased the risk of Paradoxical TB-IRIS.ConclusionParadoxical TB-IRIS, while often leading to clinical deterioration and hospitalization, is generally manageable. It appears to have a positive impact on the recovery of CD4 + T-cell counts over time. Importantly, our data suggest that INSTI-based ART regimens do not elevate the risk of TB-IRIS. Thus, paradoxical TB-IRIS should not be considered an impediment to initiating ART in adults with advanced immunodeficiency, except in the case of tuberculous meningitis (TBM).

Tuberculosis Coinfection among COVID-19 Patients: Clinical Presentation and Mortality in a Tertiary Lung Hospital in Indonesia.

Tuberculosis (TB) and coronavirus disease 2019 (COVID-19) are the top two killers of infectious disease. We aimed to determine the association of TB coinfection with the inhospital mortality of COVID-19 patients in Indonesia as a TB-endemic country. We conducted a retrospective cohort study in a tertiary lung hospital in Indonesia. All TB-coinfected COVID-19 patients who were hospitalized between January 2020 and December 2021 were included in the study. COVID-19 patients without TB were randomly selected for the control group. Clinical characteristics and laboratory results were assessed. Survival analysis was performed to determine the estimated death rate and median survival time (MST). Multivariate Cox regression analysis was conducted to define the association of TB coinfection with the in-hospital mortality of COVID-19. We included 86 (8.3%) TB coinfections among 1034 confirmed COVID-19 patients. TB coinfection patients had younger age, malnutrition, and different symptoms compared to the COVID-19 group. TB-coinfected patients had a lower estimated death rate than the COVID-19 group (6.5 vs. 18.8 per 1000 population). MST in the COVID-19 group was 38 (interquartile range 16-47) days, whereas the same observation time failed to determine the MST in the TB coinfection group. TB coinfection had a crude hazard ratio of mortality 0.37 (95% confidence interval [CI] 0.15-0.94, P = 0. 004). The final model analysis including age, sex, and lymphocyte as confounding factors resulted in an adjusted HR of mortality 0.31 (95% CI 0.1-0.9). This study showed TB coinfection was negatively associated with the in-hospital mortality of COVID-19.

Evaluation of the impact of rifampicin on the plasma concentration of linezolid in tuberculosis co-infected patients.

Linezolid combined with rifampicin has shown excellent clinical outcomes against infection by multi-resistant Gram-positive bacteria. However, several studies have indicated that rifampicin reduces the plasma concentration of linezolid in patients with severe infection. Linezolid has been recommended for the treatment of patients with multidrug-resistant or extensively drug-resistant tuberculosis. However, studies on the interaction between linezolid and rifampicin in patients suffering from tuberculosis with infection are lacking. We evaluated the interaction between linezolid and rifampicin based on therapeutic drug monitoring (TDM). A retrospective analysis was undertaken for patients with tuberculosis and infection who were treated with linezolid and undergoing TDM. Patients were divided into the linezolid group and linezolid + rifampicin group. Data on demographic characteristics, disease, duration of linezolid therapy, and the plasma concentration of linezolid were used for statistical analyses. Eighty-eight patients with tuberculosis and infection were assessed. Values for the peak (Cmax) and trough (Cmin) concentrations of linezolid in plasma were available for 42 and 46 cases, respectively. Patients in the linezolid group had a significantly higher Cmax [15.76 (8.07-26.06) vs. 13.18 (7.48-23.64) mg/L, p = 0.048] and Cmin [8.38 (3.06-16.53) vs. 4.27 (0.45-10.47), p = 0.005] than those in the linezolid + rifampicin group. The plasma concentration of linezolid increased obviously in two patients after rifampicin discontinuation. However, the total efficiency and prevalence of hematologic adverse reactions were not significantly different in the linezolid group and linezolid + rifampin group. The plasma concentration of linezolid decreased upon combination with rifampicin, suggesting that TDM may aid avoidance of subtherapeutic levels of linezolid upon co-treatment with rifampicin.

The Analysis of The Effectiveness of Pulmonary Tuberculosis and HIV-Co-TB Treatment Therapies at Sulianti Saroso Infectious Diseases Hospital

Mycobacterium tuberculosis causes Tuberculosis (TB), an infectious disease. The study aims to evaluate DOTS therapy's impact on pulmonary TB and TB-HIV patients. This research used a descriptive qualitative study design with a retrospective descriptive research approach using secondary data for the period June 2017 to July 2020. The analysis uses the Miles and Huberman model. A study of 305 people found that 83% of pulmonary TB cases completed treatment within the initial phase, 64% completed the continuation phase. TB-HIV cases 93% completed treatment within the initial phase, 71% the continuation phase. The combination of OAT and ARV doses was successful in reducing initial smear conversion in pulmonary TB cases. The treatment was evaluated as cure in pulmonary TB cases, complete in pulmonary TB-HIV cases, and had no treatment failure status in both groups. Treatment success in pulmonary TB patients was not significantly related (p-value≥5%) with the type of OAT, type of PMO, gender, and age. Whereas in HIV co-infected pulmonary TB patients, treatment success was significantly related (p-value <5%) with the type of PMO, and not related (p-value≥5%) with the type of OAT, gender, and age.

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.

Characteristics and treatment outcomes of co-infected tuberculosis patients with human immunodeficiency virus in Southeast China, 2012–2021

BackgroundTuberculosis (TB) is a chronic respiratory infection. Co-infection with human immunodeficiency virus (HIV) has been a significant obstacle to TB control. Insufficient attention has been given to TB/HIV, and more information is needed to address this issue. We conducted an observational study to investigate the epidemiological characteristics, treatment outcomes and its associated factors of HIV-positive TB patients in Southeast China.MethodsAn observational study was conducted based on data collected directly from China National TB Surveillance System during 2012–2021. Epidemiological characteristics, drug resistance and outcomes were described as frequency (n) and percentage (%). Risk factors for unsuccessful outcomes were determined using univariate (chi-squared) and multivariate logistic regression analysis.ResultsA total of 347 TB/HIV cases were included, and the proportion of HIV-positive cases among all TB cases increased significantly from 0.06% to 2012 to 0.40% in 2021. The majority of cases were males (86.5%), non-local household registers (139, 40.1%), farmers or workers (179, 51.6%), and aged 40–59 (142, 40.9%). Of 347 cases, 290 (83.6%) had pulmonary TB (PTB), 10 (2.9%) had extra pulmonary TB (EPTB) and 47(13.5%) had both PTB and EPTB. A total A total of 258 (74.4%) were HIV positive prior to TB diagnosis. 8.0% (4/50) of cases were resistant to rifampicin (RIF) and 274 patients (83.8%) had successful outcomes. Being non-local (AOR = 2.193, 95% CI = 1.196–4.022, P = 0.011) and diagnosed HIV infection after TB (AOR = 2.365, 95% CI = 1.263–4.430, P = 0.007) were independent risk factors for unsuccessful outcomes of anti-TB treatment.ConclusionDuring 2012–2021, the proportion of HIV-positive cases among all TB cases increased significantly in Southeast China. HIV-positive TB patients were significantly more likely to develop resistance to RIF and INH and unsuccessful anti-TB treatment. Non-local registration and becoming HIV positive after TB diagnosis were independent risk factors associated with unsuccessful outcomes.

An Initiative Report on Hospitalized Pulmonary TB Patients Co-Infected by SARS-CoV-2 during the COVID-19 Pandemic from Tertiary Referral Hospitals in Surabaya

The enduring effect of SARS-CoV-2 pandemic has been experienced throughout the past and ongoing three years. Incidences of SARS-CoV-2 co-infected tuberculosis patients were reported globally, including in Italy and several European countries and resulted in a more complicated disease with severe clinical features and poorer clinical outcomes. To effectively manage this co-infection, it is important to be informed of the prevalence and characteristics of an acute SARS-CoV-2 co-infection on TB and determining factors of severity. Therefore, early warning signs can be recognized, monitored closely and managed. This retrospective study, carried out on hospitalized TB patients in Dr. Soetomo Hospital and Universitas Airlangga Hospital, Surabaya, Indonesia, used medical records from March 2020 to December 2022. Samples were from inpatients with a molecularly-Gene Xpert MTB/Rif-confirmed tuberculosis, and currently experienced respiratory and fever symptoms that resembles the symptoms of SARS-CoV-2 infection or exacerbation of tuberculosis. They are then screened and examined using a molecular diagnostic test, with real-time RT-PCR for SARS-CoV-2. A total of 54 (0.7%) patients had TB-SARS-CoV-2 co-infection among 7,786 suspected to have TB, of which 35 had Rifampicin Sensitive (TB-RS), while 19 had TB Rifampicin Resistant (TB-RR) co-infected with SARS-CoV-2. The remaining 2,586 suspected TB patients had only MTB, based on the detection methods of X-pert MTB/RIF, but with negative RT-PCR of SARS-CoV-2. The clinical severity and mortality of TB-SARS-CoV2 co-infected patients were significantly associated with the number of co-morbidities (p=0.0156), and serum haemoglobin levels (p=0.0672), in which p value < 0.05 is considered significant.

Tuberculosis and human immunodeficiency virus co-infected patients’ mortality rate and its predictors in Dire Dawa, Eastern Ethiopia, 2018

Background: Tuberculosis and human immunodeficiency virus (TB/HIV) co-infection is an important global public health problem and result multidirectional tricky. The mortality rate of co-infected patient’s comes from many aspects or factors. Identification of these factors is important for planning and for the intervention of care and treatment. The aim of this study was to examine the co-infected patients’ mortality rate and its predictors. Methods: A five-year retrospective cohort study was employed among 471 randomly selected TB/HIV co-infected patients enrolled from January, 2012 to December, 2016. Relevant variables of data were collected from patients ‘medical cards. The collected data were entered into Epi-data 4.2.0.0 and exported to SPSS version 24 for analysis. Univariate analyses were used to describe the baseline characteristics of the patients. Kaplan Meir curve were used for the comparison of time to recovery among the different groups of patients and Cox model was used to identify independent predictors. Results: A total of 79 (16.8%) deaths occurred during the median follow-up period of 685 days. being infected with pulmonary tuberculosis (PTB) [AHR=1.99 (95% CI:1.16-3.41)], WHO clinical stage III [AHR=2.88 (95% CI:1.56-5.30)], IV [AHR=4.20 (95% CI:2.21-8.01)], ambulatory functional status [AHR=4.15 (95% CI:1.57-10.98)], bedridden functional status [AHR=6.34 (95% CI:2.43-16.59)] and delayed Co-trimoxazole preventive therapy [AHR=2.45 (95% CI:1.54-3.91)] were important predictors associated with high mortality rate of TB/HIV co-infected patients. Conclusions: about one to six TB/HIV co-infected persons died in their course of treatment follow-up. Important contributing factors were PTB infection, WHO clinical staging III and IV, ambulatory and bed ridden functional status and delayed co-trimoxazole preventive therapy.

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 <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 <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 <200 cell/cu.mm.

Perceptions and challenges among health care providers about HIV-TB co-infected children- A qualitative study

BackgroundHuman immunodeficiency virus – Tuberculosis (HIV-TB) co-infected patients have a greater risk of mortality, treatment failure, and recurrence. The significant morbidity and mortality rates associated with tuberculosis and human immunodeficiency virus infection in children cause concern. India aims to enhance the detection and treatment of HIV-TB cases in children and coordinate TB & HIV care. ObjectiveTo explore the perceptions and challenges of health care providers regarding the diagnosis and treatment of Tuberculosis in HIV-TB co-infected children. Materials and methodIn-depth interviews among 14 health care providers were conducted in ART centers of 5 talukas of Belagavi district to identify health care providers' perceptions and challenges regarding pediatric HIV-TB diagnosis and treatment. Interviews were conducted after receiving informed consent. ResultsChallenges during HIV-TB diagnosis and treatment in children: difficult to get sputum sample for CBNAAT and child was unable to complain about symptoms, caregivers were not able to mention the signs/symptoms correctly, unavailability of a pediatrician in few Taluka ART centers, delay in receiving TB lab report, challenging to feed drugs to an infant, higher loss to follow-up, financial problem, distance from centers, low community awareness, poverty and illiteracy, stigma and death due to TB treatment default. ConclusionEfforts such as expanded health care providers, community education, and a constant supply of HIV rapid test kits are required to ensure successful diagnosis and treatment of HIV-TB co-infected children.

The clinical characteristics and risk factors for severe COVID-19 in patients with COVID-19 and tuberculosis coinfection.

Under the wave of the severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) variant Omicron epidemic, the number of infectious cases has increased dramatically in Jilin Province, China since March 2022.The clinical features and severity of SARS-CoV-2 Omicron variant infection in tuberculosis (TB) patients are not yet clear. Data were obtained from 153 patients with the Omicron variant and TB coinfection and 153 non-TB COVID-19 patients who had been hospitalized at Changchun Infectious Disease Hospital from March to June 2022. Among these coinfection patients, 17 patients showed COVID-19-related pneumonia on chest imaging and 11 were diagnosed with severe COVID-19. The median duration of SARS-CoV-2 clearance was 13 days. The negative conversion time was associated with age, COVID-19-related pneumonia and antibody IgG. A higher white blood cell count, a lower lymphocyte percentage, a higher CRP level, and a higher D-dimer level were found in the severe group. Age and increased PCT were individual risk factors for the severity of COVID-19. Compared with the non-TB patients, the coinfection patients had higher severity of COVID-19 and the elder coinfection patients had a longer negative conversion time. This study found an association between age, pneumonia, antibody IgG and RNA negative conversion time in COVID-19 and TB coinfection patients, and age and increased PCT were risk factors for the severity of COVID-19.

Tuberculosis and COVID-19 co-infection in Serbia: Pandemic challenge in a low-burden country.

COVID-19 and tuberculosis (TB) represent global threats to the public health system. The impact of COVID-19 on TB results in a reduction in the number of notified TB cases, delayed diagnosis and treatment, and increased case fatality and mortality rates. The aim of the study was to analyze the TB/COVID-19 co-infected cohort in Serbia as a low-burden country and compare it to the global TB/COVID-19 cohort. A retrospective analysis was done on 53 TB and COVID-19 co-infected patients treated in COVID hospital "Batajnica" in Belgrade and Special Hospital for Pulmonary Diseases "Ozren" Sokobanja in the period from 6 March 2020 to 1 April 2022. A comparative analysis with the global cohort published recently was also performed. TB/COVID-19 cohort in Serbia included significantly fewer migrants and diabetes cases, but more cases with chronic respiratory diseases compared to the global. Descriptive analysis of TB cases in the Serbian TB/COVID-19 cohort showed fewer cases diagnosed with sputum smear and Gene Xpert/HAIN, fewer EPTB and mono-resistant cases, and more cases diagnosed with solid culture, unilateral pulmonary infiltrate (with bilateral cavity lesions), and bilateral pulmonary infiltrate (no cavities) compared to TB/COVID-19 cases worldwide. Nasal congestion and fever were more common COVID-19 symptoms in the global cohort. Radiology was more commonly used for the diagnosis of COVID-19 in Serbia. Typical bilateral ground opacities were less common among Serbian patients. Serbian patients spent fewer days in the hospital and achieved a higher PCR conversion rate and TB treatment success rate. The Serbian TB/COVID-19 cohort achieved a higher treatment success rate compared to the global cohort. Encouraging vaccination against SARS-CoV-2 for people with a current or past TB disease, as well as rapid diagnosis and targeted treatment of TB in highly specialized pulmonology institutions, presents key points to avoid excessive morbidity and mortality.

Effect of active tuberculosis on the survival of HIV-infected adult patients who initiated antiretroviral therapy at public hospitals of Eastern Ethiopia: A retrospective cohort study.

In resource-limited countries such as Ethiopia, tuberculosis is the major cause of morbidity and mortality among people living with the human immunodeficiency virus. In the era of antiretroviral therapy, the effect of tuberculosis on the survival of patients who are living with human immunodeficiency virus has been poorly understood in Ethiopia. Therefore, this study aimed to determine the effect of active tuberculosis on the survival of HIV-infected adult patients who initiated antiretroviral therapy in public hospitals in Eastern Ethiopia. An institution-based retrospective cohort study was conducted among 566 participants from January 1, 2014, to June 30, 2018. The collected data were entered into EpiData version 3.1 before being exported to Stata version 14 for analysis. A Cox proportional hazard model was used to determine the effect of active tuberculosis on the survival of HIV-infected adult patients who initiated antiretroviral therapy, and a p-value less than 0.05 and a 95% confidence level were used to declare statistical significance. Of the 566 patients included in the study, 76 died. The mortality rate was 11.04 per 100 person-years in tuberculosis co-infected patients, while it was 2.52 per 100 person-years in non-tuberculosis co-infected patients. The patients with tuberculosis co-infection had a 2.19 times higher hazard of death (AHR: 2.19; 95% CI: 1.17, 4.12) compared to those without tuberculosis. Advanced clinical stage, low CD4+ cell count, and previous episodes of an opportunistic infection other than tuberculosis were found to be independent predictors of mortality. Co-infection with tuberculosis at antiretroviral therapy initiation increases the hazard of death approximately two-fold. Hence, we recommend key organizations to enhance the region's collaborative interventional and preventative strategies for TB and HIV.

Role of HIV Infection in Multi-Drug Resistant Tuberculosis in Parts of Benue State, Nigeria

The pathogenesis of Tuberculosis shows that M. tuberculosis target and persist within phagocytes including T-lymphocytes in blood circulation. As a result, the possibility of cellular interaction between M. tuberculosis and HIV, especially for patients that are co-infected with HIV and TB, and subsequent exchange of genetic material via transduction needs to be investigated. Three hundred and eighty sputum samples mostly from suspected rifampicin-resistance patients were collected from Nigerian Airforce (NAF) Hospital Makurdi, and Federal Medical Centre (FMC) Makurdi. In vitro culture of sputum samples, Drugs Susceptibility Testing (DST) of M. tuberculosis isolates, and transduction protocol were carried out at the National Tuberculosis and Leprosy Training Centre (NTBLTC) Zaria, Nigeria. Statistical analysis was carried out using Student’s t-test. Minitab version 14.0 statistical software was used for data analysis. P-values < 0.05 were considered significant. Twenty-six (9.7%) cases of Multi-drug resistant tuberculosis (MDR-TB) were detected (retreated cases 7.1%; treatment naive 2.6%). Twenty-one (80.8%) were males and 5(19.2%) were females. There was statistical difference in MDR-TB between male and female in Benue State (P<0.05). The mean age group 35-45 years had the highest cases of MDR-TB accounting for 35% of MDR-TB. Human-immunodeficiency virus and Tuberculosis co-infected patients (category I) had the highest MDR-TB incidence of 10(38.5%). There was no significant difference between category-1 and category-III [patient with only TB disease (P>0.05)]. However, there were elevated cases of MDR-TB in category-III patients from 7(26.9%) to 10(38.5%) following transduction protocol. Multi-drugs resistant tuberculosis is prevalent in Benue State, affecting the most economically active youths within the age group of 35-45 years, as a result the need to direct more attention on molecular basis for M. tuberculosis drugs resistance is therefore advocated, in order to win the war against multi-drug resistant tuberculosis.

Clinical Features and Treatment Outcome of Coronavirus and Tuberculosis Co-Infected Patients: A Systematic Review of Case Reports.

BackgroundCoronavirus disease 19 (COVID-19) and Mycobacterium tuberculosis (MTB) are among the top ongoing health crises globally. Both cause respiratory diseases, and the clinical presentations are similar. There is no summarized information about cases of COVID-19 patients with concomitant TB infection from different settings. Therefore this review aimed to summerize the clinical features and treatment outcomes of coronavirus and tuberculosis co-infected patients.MethodsAn electronic search of case reports published between 2020 and 2021 was conducted using Google Scholar, PubMed, Scopus, and ScienceDirect. From eligible reports, data were collected for the selected variables. We analyzed the collected information using SPSS version 27 software. Descriptive statistics were computed for the selected variables.ResultsA total of 83 patient histories were collected from 47 case reports. The majority (80%) of the cases were reported for male patients. The mean age was 42.6 years (3 months to 84 years, SD=17.3). Fever was reported in 80% of cases, followed by cough (73.3%) and hypotension (37.1%). Blood cell parameters revealed lymphopenia (52%), lower hemoglobin (30%), elevated CRP (70%), elevated ferritin (28%), and increased D-dimer (23.4%). Treatment outcome is significantly associated with blood cell count results (p-0.044) and a rise in blood inflammatory cytokines(p-0.041). The mean days for viral clearance or negative PCR was 23 days (Range 5–82 days) and the overall mean duration of hospitalization was 27 days. The total death rate was 22.4%. Recovery was reported for 76.6% of cases. Survival status (p-0.613) and disease severity (p-0.68) are not significantly associated with the gender of the participants.ConclusionAn alteration in blood cell parameters is associated with an unfavorable treatment outcome. There is a higher death rate in COVID-19/TB co-infection. The death is associated with older age, smoking or smoking history, drug abuse, and co-morbidity of non-communicable diseases. Conversely, there is a lower death rate in HIV patients.

Modeling Survival Time to Death Among TB and HIV Co-infected Adult Patients: an Institution-Based Retrospective Cohort Study.

Tuberculosis is a serious health threat, particularly for people living with human immunodeficiency virus (HIV), and HIV-positive people are more likely than others to contract the disease. Globally, tuberculosis (TB) is one of the leading causes of death among people living with HIV. The purpose of the current study was to identify factors associated with survival rates of TB/HIV co-infected patients using survival models. A retrospective study was conducted on TB/HIV co-infected adult patients registered and under follow-up at Tepi General Hospital (TGH) and Mizan-Tepi University Teaching Hospital (MTUTH), southwest Ethiopia. All TB/HIV co-infection patients who were registered and under follow-up from 1st January 2015 through 1st January 2020 were considered. The global Schoenfeld test was used to test the proportional hazard (PH) assumption. Various accelerated failure time (AFT) models were compared to determine the best model for the time to death of TB/HIV co-infected patients' data set. Among the most commonly used accelerated failure time models (AFT models), the study used exponential, Weibull, log-logistic, and log-lognormal AFT models. AIC and BIC were used to compare the performance of fitted models. The data were analyzed with the statistical software R. Of 363TB/HIV co-infected patients followed for 60months, 79 (21.8%) died, while the remaining 284 (78.2%) were censored. The overall median survival time was 15.6months. The proportional hazard assumption was checked and it was violated. In comparison to other models, the lognormal AFT model performed better. The results of the multivariable lognormal AFT model showed that age, residence, substance use, educational status, clinical stages of the disease, cluster of differentiation 4 (CD4 count/mm3), functional status, cotrimoxazole prophylactic therapy use (CPT use), and INH were all found to be significant factors, while gender, illness other than TB, and disclosure of status were insignificant variables at 5% level of significance. Current study results revealed that older age, substance use, advanced WHO clinical stages of the disease (stage IV), bedridden functional status, and CD4 less than 200 count/mm3 were significantly associated with shorter survival time to death of HIV/TB co-infected patients while having advanced educational status, being from urban residence, CPT use, and INH significantly increase the survival time to death of TB/HIV co-infected patients.Patients with TB/HIV co-infection should be given special attention based on these important factors to improve their health and prolong their lives. HIV-positive patients are more likely than others to contract the TB disease. The risk of death among TB/HIV co-infected patients was found to be high. Out of all patients, 79 (21.8%) died. Accelerated failure time models are good alternatives for scenario Cox proportional hazard assumptions not met.

Implementation of WHO guidelines on management of advanced HIV disease and its impact among TB co-infected patients in Tanzania: a retrospective follow-up study

BackgroundThe commonest causes of mortality in people living with HIV (PLHIV) are preventable and the majority can be attributed to undiagnosed tuberculosis (TB). National HIV/AIDS control programs are encouraged to implement the WHO package of interventions to improve survival among PLHIV. We assessed the implementation of the WHO TB-related package of care for Advanced HIV Disease (AHD) and its impact on treatment outcomes among HIV/TB patients in Tanzania.MethodsA retrospective cohort study was employed among HIV/AIDS patients on antiretroviral therapy from 21 public health facilities in three regions (Dar es Salaam, Coastal, and Morogoro) of Tanzania. Patients enrolled in care between January 2013- June 2017 (before the introduction of the WHO guidelines) and July 2017-Sept 2018 (during the implementation of the guidelines) were recruited. Data abstraction was done from patient hospital files using a structured questionnaire uploaded on a tablet.ResultsData from 2624 patients records were collected. Overall, 50% of patients with HIV had AHD with 7.8% of these co-infected with TB. Among AHD participants, 58.3% were female, 80.7% were from urban areas and 40.0% visited care and treatment centres as self-referrals. Implementation of the WHO AHD package of care was very low, ranging from 0% for Urine LF-LAM test done among patients with symptoms and signs of TB to 39.7% AHD concurrent with TB patients whose ART initiation was deferred for 2 weeks. Overall, the Proportion of AHD patients diagnosed with TB was 4.8%, Of which sputum Xpert as the first test for TB diagnosis was 4.4%. Five patients (0.6%) were documented to have received IPT at enrolment. Tailored counselling to ensure optimal adherence to ART for viral suppression was given to 12.1%.AHD patients co-infected with TB were retained in care more before the introduction of WHO AHD guideline (82.1%) compared to the period after the introduction of the guideline (53.9%) (p = 0.008). Clinical failure at 6 months among AHD patients was 10.6% before the guideline and 11.4% after the guideline. Immunological failure was observed in 1 patient (9.1%) before the guideline and 1 patient (7.1%) after the guideline. After the introduction of the guideline, mortality was 5.9% and no mortality was observed before the guideline. All the differences were not statistically significant.ConclusionsImplementation of the TB related WHO packages of care for AHD is very low. Except for TB diagnosis, other parameters did not improve with the introduction of the guidelines. More research is recommended to ascertain the effectiveness of guidelines as well as an understanding of the mechanisms involved.

Baseline IL-6 is a biomarker for unfavourable tuberculosis treatment outcomes: a multisite discovery and validation study.

BackgroundBiomarkers of unfavorable tuberculosis treatment outcomes are needed to accelerate new drug and regimen development. Whether plasma cytokine levels can predict unfavorable tuberculosis treatment outcomes is unclear.MethodsWe identified and internally validated the association between 20 a-priori selected plasma inflammatory markers and unfavorable treatment outcomes of failure, recurrence and all-cause mortality among adults with drug-sensitive pulmonary tuberculosis in India. We externally validated these findings in two independent cohorts of predominantly diabetic and HIV coinfected tuberculosis patients in India and South Africa, respectively.ResultsPre-treatment IFN-γ, IL-13 and IL-6 were associated with treatment failure in the discovery analysis. Internal validation confirmed higher pre-treatment IL-6 concentrations among failure cases compared to controls. External validation among predominantly diabetic tuberculosis patients found an association between pre-treatment IL-6 concentrations and subsequent recurrence and death. Similarly, external validation among predominantly HIV coinfected tuberculosis patients found an association between pre-treatment IL-6 concentrations and subsequent treatment failure and death. In a pooled analysis of 363 tuberculosis cases from the Indian and South African validation cohorts, high pre-treatment IL-6 concentrations were associated with higher risk of failure (adjusted odds ratio [aOR]=2.16, 95%CI 1.08-4.33, p=0.02), recurrence (aOR=5.36, 95%CI 2.48-11.57, p<0.001) and death (aOR=4.62, 95%CI 1.95-10.95, p<0.001). Adding baseline IL-6 to a risk-prediction model comprising of low BMI, high smear grade and cavitation improved model performance by 15 percent (C-statistic of 0.66 versus 0.76, p=0.02).ConclusionPre-treatment IL-6 is a biomarker for unfavorable tuberculosis treatment outcomes. Future studies should identify optimal IL-6 concentrations for point-of-care risk prediction.

GeneXpert® assay; and its performance for the diagnosis of HIV-associated tuberculosis: Is scale-up worth it?

Background: Synergistic Tuberculosis (TB) and human immunodeficiency virus (HIV) co-infections are responsible for epidemics in several nations and have established themselves as a tremendous health challenge to these nations in terms of patient point of care and economic burden on health care organizations. TB is the fundamental driver of HIV-related mortality around the world. Co-infection with these two pathogens results in an accelerated course for the two illnesses and raises complex challenges in diagnosis and therapy. TB and HIV both work in synergy to accelerate the deterioration of the immunological defense mechanisms often leading to death. This present study was designed to evaluate the performance of GeneXpert assay for the detection of Mycobacterium tuberculosis among HIV positive and negative TB patients. Methods and materials: The present prospective cross-sectional study was conducted in the Mycobacteriology laboratory, Allama Iqbal Medical College, Lahore, Pakistan from 2011–2017. A total of 3784 (HIV-ve n = 3568, HIV +ve n = 216) sputum samples were collected with complete history from patients strongly suspected for pulmonary TB (PTB) patients. HIV status was evaluated by PCR (Quantitative) and then referred for Flow-cytometry and GeneXpert assay for MTB Results: Out of a total of n = 3784 PTB, the prevalence of HIV was 5.7% (n = 216/3784). Of 216 HIV positive, 15.7% (n = 34) were also co-infected with TB. The sensitivity of the ZN smear and GeneXpert assay was considerably reduced among HIV and TB co-infected patients. The sensitivity and specificity of ZN smear was 63.7%, and 100% among HIV negative compared to 23.5% and 100% among HIV positive individuals respectively. Whereas sensitivity and specificity of the GeneXpert were found to be 94.5% and 100% for HIV negative individuals as compared to the 76.4%, and 100% respectively among the HIV positive patients. Furthermore, in the case of smear-negative samples, GeneXpert assay showed noticeable sensitivity and specificity 85.8%, 100% and 69.2%, 100%, respectively for HIV negative and positive patients. Conclusion: The GeneXpert assay showed an overall better sensitivity compared to the ZN smear for the diagnosis of TB, the sensitivity was much less in TB patients co-infected with HIV, compared to the HIV negative patients.