Tuberculosis In HIV-seropositive Patients Research Articles

Incidence of Tuberculosis in HIV Sero-positive Patients at HIV Clinic at Kampala International University Teaching Hospital, Bushenyi District

This study on the prevalence of TB among HIV sero-positive was carried at the HIV CLINIC of Kampala International University Teaching Hospital (KIUTH), Ishaka Bushenyi district. A retrospective cross-sectional study design was used to conduct this research. The study targeted all patients attending KIUTH HIV/TB clinic. A standard structured and semistructured questionnaires were designed and pre-tested for validity and reliability at Kampala International University Teaching Hospital HIV/Tuberculosis clinic before being used for data collection. Data collection started by recruitment of qualified research assistants, appropriate training and orientation of the interviewers before the survey for example when reading the questions. Quantitative methods of data analysis was used in which data was presented in form of bar charts, graphs and tables. The prevalence of TB among HIV sero-positive patients attending HIV clinic at KIUTH stands at 8.06 per 100 participants. The study found that generally, people are aware about the modes of transmission of TB but there is still need for more awareness. Many patients are still not certain whether TB is curable in HIV patients. As seen from the above study, most of the people are not yet aware whether HIV goes hand in hand with tuberculosis. The prevalence of TB in HIV sero-positive attending HIV clinic at KIUTH is high. Generally, TB is affecting patients of all ages and most patients are still not aware if TB in HIV is curable. Most patients have a perception that all TB patients have HIV. Health workers in HIV clinic of KIU-TH should teach patients the modes of transmission and prevention of TB. KIUTH also need to provide easy access to TB screening services to patients. There is need for financial support by the government to the unemployed patients and low-income earners in order to curb TB infections. Keywords: Tuberculosis, HIV, Sero-positive, Bushenyi District

Genetic polymorphism of toll-like receptors in HIV-I infected patients with and without tuberculosis co-infection.

Toll-like receptors (TLRs) are identified as one of the key components of innate immune system due to their ability to sense conserved molecular motifs associated with several pathogens. It has been implicated from several evidence that mutations in genes encoding TLRs are associated with increased or decreased susceptibility to various infectious diseases. The study was prospective, cross-sectional, as well as longitudinal in nature, which includes 223 HIV-positive patients, 150 HIV-positive patients with latent tuberculosis (TB) infection, 150 HIV-positive patients with active TB, 200 HIV-negative newly diagnosed sputum smear positive pulmonary TB patients, and 205 healthy subjects. A statistically significant difference was observed in allelic frequencies of TLR4 between healthy subjects and HIV + TB patients (P < 0.001), healthy subjects, and pulmonary TB (PTB) Category-I patients (P < 0.01) and between healthy subjects and HIV + TB patients (P < 0.001). TLR4 genotype frequencies were also significantly different between healthy subjects and PTB Cat I patients (P < 0.001) and HIV + and HIV + TB patients (P < 0.01). A statistically significant difference was also observed between HIV + and PTB Cat I patients (P = 0.04), HIV + LTBI and HIV + TB patients (P = 0.01), and between HIV + TB and PTB Cat I patients (P < 0.01). This study implicates that Asp299Gly polymorphism in TLR4 gene is associated with increased susceptibility to active TB in HIV-seropositive patients. Increased frequency of 'A' allele in TLR9 gene was also discovered at the time of active TB development in ART naïve HIV + patients, who developed active TB on follow-up.

Trend of HIV-TB co-morbidity?in north-west region of Uttarakhand

Tuberculosis (TB) is the commonest opportunistic infection and the number one cause of death in HIV patients in developing countries. HIV co-infection is the most powerful known risk factor for progression of M. tuberculosis infection to active disease, increasing the risk of latent TB reactivation. The study was carried out to study the trend of Tuberculosis in HIV seropositive patients and determine HIV-TB co-morbidity in Dehradun, Uttarakhand. A retrospective study of standardized patient records was conducted from December 2017 to November 2018 of all HIV sero-positive patients registered to ART PLUS Centre Govt. Doon Hospital Dehradun. TB suspected patients were referred to RNTCP. Data was taken and analyzed by Microsoft Excel. Among total of 18319 HIV positive patients attending ART centre (ART and Pre- ART enrolled) during the study period, 585 patients were suspected of TB and were referred from ART to RNTCP. Total 128 (21.9%) patients were diagnosed with TB, of which 71(55.46%) patients were diagnosed for pulmonary TB and 57(44.5%) were Extra-Pulmonary TB. In our study Male predominance was seen and most of the cases were of age group 19-40 years, mostly belonging to rural areas. Keywords: HIV/AIDS, Tuberculosis, Co-infection.

Clinical and Radiological Profile of Pulmonary Tuberculosis in HIV Seropositive Patients in Relation to CD4 Count

Clinical and Radiological Profile of Pulmonary Tuberculosis in HIV Seropositive Patients in Relation to CD4 Count

The multiple faces of tuberculosis in HIV infected patients – a continuous challenge

Tuberculosis (TB)/HIV co-infection represents a major problem in many regions of the world, including Romania. TB is a leading cause of death among people infected with HIV and HIV infection is the most important risk factor for progression from latent to active TB. TB can occur at any stage of HIV disease and its manifestations depend on the severity of immunosuppression. The proportion of extra-pulmonary tuberculosis in HIV infected patients has increased. Aim: to analyze the cases of pulmonary and extrapulmonary TB in HIV-seropositive patients monitored in Third Department of the “Matei Bals” Institute. We performed a retrospective analysis of all HIV infected patients monitored in our clinic from 2000 to 2014 in order to establish the location of TB, the diagnosis methods, the correlation with the immune status and the outcome. 122 patients were retrospectively analyzed; from them, 18 patients were diagnosed with certain, probable or possible TB infection (14.75%). Sex ratio in TB group was M:F=1.57:1 and mean age was 39.7 years old at the moment of TB diagnosis. TB occurs at a variable level of immunosuppression (CD4 count from 6 to 460/cmm) - 4 patients (22.2%) in stage 2 - CD4=200-500/cmm and 14 patients (77.8%) in stage 3 - CD4<200/cmm. Mean CD4 count in TB group was 113.23/cmm vs. 218.33 mean nadir CD4 count in non-TB group. Pleuro-pulmonary TB accounted for only 27.7% of all cases - one pleural effusion and 4 pulmonary TB. In most of cases, TB infection was extrapulmonary (72.3%): 5 cases of meningoencephalitis (27.7%), 3 cases of disseminated TB (16.66%), 2 cases of lymph node TB (11.11%) and 3 cases with unknown location (16.66%). TB was microbiologically confirmed in only 6 cases – 33.33%, 3 by blood culture, 2 by PCR (one from CSF and one from pleural effusion) and 1 by histopathologic exam (lymph node biopsy). In 9 cases TB was probable but without bacteriologic confirmation and in 3 cases TB was possible – prolonged fever with a good outcome under anti-TB medication. Quantiferon TB was performed in only 8 cases – in 6 cases was positive, in one case was negative and in one case was undetermined. Three patients died: one patient because of disseminated TB and two patients because of other HIV-related comorbidities. HIV infected patients developed especially extra-pulmonary TB infection. TB can occur in any stage of HIV infection. Microbiological diagnosis in TB is positive in a small number of cases.

Treatment outcome of newly detected pulmonary Tuberculosis in HIV-seropositive and HIV-seronegative patients

Background: HIV infection is the strongest of all known risk factors for the development of tuberculosis. Tuberculosis is the most common opportunistic infection and the number one cause of death in HIV/AIDS patients in developing countries. Materials and Methods: The aim of this study is to assess and compare the outcome of pulmonary tuberculosis in HIV-seropositive and HIV-seronegative patients. This was cross-sectional, observational and prospective study conducted at tertiary care center in western Maharashtra from May 2010 to April 2012. A total 50, HIV-seronegative patients and 50 HIV-seropositive patients of both genders, with pulmonary tuberculosis fulfilling inclusion criterion (age > 18 years, newly detected pulmonary tuberculosis) were included in present cross-sectional, observational, prospective and comparative study. Results: Of the total 50 HIV-seropositive patients, 36 (72%) males were newly detected pulmonary tuberculosis (PTB) with mean age of 40.61 ± 8.74 years and 14 (28%) were females with mean age 37.72 ± 9.54 years. Of total 50 patients amongst HIV seronegative-group patients with PTB, 29 (58%) were males with mean age of 42.44 ± 5.79 years and 21 (42%) were females with mean age of 38.9 ± 7.91 years. A total 10/50 (20%) patients in HIV-seropositive group and 3/50 (6%) HIV-seronegative group had evidence of jaundice. There was a statistical difference between development of jaundices in HIV and HIV-seronegative group ['P' = 0.037]. Total 9/36 (25%) male patients and 2/14 (14.28%) females patients died in HIV-seropositive group with no death recorded amongst in HIV-seronegative groups with high mortality in HIV-seropositive group ['P' < 0.0001]. Total 4 male and 4 female patients had inflammatory response syndrome (IRIS). Total 40/50 (80%) patients were sputum negative at the end of 6 th month (2 nd follow-up) among HIV-seropositive group. Total 49/50 (98%) become a sputum negative at the end of 2 nd follow-up, 6 month among HIV-seronegative group there was a statistically significant difference between two group ['P' = 0.021]. Total 10/50 (20%) and 1/50 (2%) patients were diagnosed with multidrug resistant tuberculosis (MDR-TB) among HIV-seropositive group and HIV-seronegative group, respectively ['P' = 0.002]. There was high prevalence of middle and lower lobe lesions and bilateral extensive pulmonary tuberculosis (BEPT) in patients with HIV-seropositive group patients and upper lobe, miliary shadow and cavitary lesions in HIV-seronegative group patients ['P' < 0.02]. The cavitary lesions were significantly low in HIV-seropositive group with low CD+4 counts. Duration of stay was significantly more in HIV-seropositive group compared with HIV seronegative- seropositive group ['P' < 0.01]. Conclusions: We found high prevalence of MDR-TB pulmonary tuberculosis in HIV-seropositive patients. Mortality was significantly high in HIV-seropositive patients than HIV-seronegative patients. Jaundice was more prevalent in HIV-seropositive patients than HIV-seronegative patients. There was high prevalence of middle and lower lobe lesions and BEPT in patients with HIV-seropositive group patients and upper lobe, miliary shadow and cavitary lesions in HIV-seronegative group patients. The cavitary lesions were significantly low in HIV-seropositive group with low CD+4 counts. Duration of stay was significantly more in HIV-seropositive group compared with HIV-seronegative group. Success rate of directly observed treatment short-course was less (80%) in HIV-seropositive group.

The Role Of Culture In Diagnosing Smear Negative Tuberculosis In HIV Seropositive Patients.

Sputum microscopy, the most commonly practiced tuberculosis (TB) diagnostic test is less sensitive in immunocompromised patients due to low bacillary load.The study was carried out in a tertiary care general hospital during 2010-12 in Mysore, Karnataka, to diagnose smear negative TB in HIV patients by culture technique.Of416 HIV patients, 162 patients with features of pulmonary/extrapulmonary TB but smear negative were included in the study.Sputum, stool, blood and other relavent clinical samplese except blood were processed as per standard protocol. The blood collected with sodium citrate was processed by lysiscentrifugation .All samples were inoculated onto Lowstein Jensen slants and incubated at 37 0 c for 6 to 8 weeks.Of 162 HIV patients, 67(41%) were found to have TB. Extrapulmonary TB (25%) was more common than pulmonary TB (13%). Mycobacteria were recovered in 76 samples (26 sputum, 12 stool, 18 blood, 7 pleural fluid, 1 CSF, 9 FNAC, 1 ascitic fluid, 1pus ,1 ear discharge). M.tuberculosis (95%) was the predominant species isolated followed by M.avium complex (5%).Most HIV patients with TB are left undiagnosed for reasons of no advanced/high cost techniques in resource constrained settings. Thus culture could be used as a tool in diagnosing smear negative TB.

The Pattern of Presentation and Prevalence of Tuberculosis in HIV-Seropositive Patients Seen at Benin City, Nigeria

Background. The emergence of Human immunodeficiency virus (HIV), led to the rise in the incidence and prevalence of tuberculosis (TB) worldwide. However, the trend is being reversed recently due to the widespread use of effective Anti-Retrovirals. Immunosuppression induced by HIV infection modified the clinical presentation of TB, resulting in atypical signs and symptoms, and a more frequent extrapulmonary presentation. This study was undertaken to determine the pattern of presentation and prevalence of TB in HIV seropositive patients seen in Benin City, Nigeria, from January to April, 2007. Method. The study was done using 330 HIV positive patients (123 males and 207 females). A designed questionnaire was used as a diagnostic instrument. Results. The prevalence of TB HIV was found to be 33.9%. It was found to be commoner in females, commonest in the age group 30–39 years. Pulmonary TB was the commonest type of TB found (78.6%). This was followed by TB adenitis (12.5%). The incidence of extrapulmonary TB was 21.4%. There was a high incidence of atypical chest X-ray features and high frequency of negative sputum smears. Conclusions. The overall prevalence rate of TB in HIV (33.9%), and the extrapulmonary presentation of TB are high. Some investigation results were found to be atypical in those with both infections. Physicians should be aware of this pattern of presentation and the atypical findings on investigation for early diagnosis and treatment.

Issues in the treatment of Mycobacterium tuberculosis in patients with human immunodeficiency virus infection.

The HIV/AIDS pandemic has led to a rise in the incidence of tuberculosis and an epidemic of co-infection in many developing countries. Treatment of Mycobacterium tuberculosis in persons with HIV infection presents several challenges to the clinician particularly in resource-poor countries. As will be discussed in this paper diagnosis of latent tuberculosis relies on tuberculin skin testing which has poor sensitivity and reproducibility in immunocompromised patients. The World Health Organization (WHO) recommends treatment of active tuberculosis as the primary means of global tuberculosis control. In practice treatment of active tuberculosis typically requires that a symptomatic patient self-report to a health service for evaluation and management. Even if this approach to tuberculosis control were sufficient many logistic and clinical problems remain involving tuberculosis diagnosis and therapy in the patient with HIV/AIDS. Recognizing the significant clinical and public health challenges surrounding the treatment of tuberculosis in patients with HIV infection this paper will address a number of issues relevant to the care of co-infected patients. These include current guidelines for the treatment of active tuberculosis as well as the diagnosis and treatment of latent tuberculosis in HIV-positive patients. The paper concludes with a discussion of promising new drugs for tuberculosis treatment. (excerpt)

Screening for tuberculosis in an east London HIV clinic.

A prospective study was carried out to assess the value of routine skin tuberculin testing and chest radiography in HIV seropositive patients, attending the Genitourinary Medicine (GUM) clinic between July 1991-May 1992. 144 consecutive HIV seropositive patients had tuberculin Tine tests and chest radiographs performed. Ten patients were treated for active tuberculosis (TB) on the basis of abnormal radiography with or without strongly positive (Grade 3/4) skin tuberculin tests. A further 10 patients received prophylaxis on the basis of abnormal chest radiography consistent with previous tuberculous infection or strongly positive tuberculin tests. Active or previous tuberculous infection was found in the UK born Caucasian homosexual population as well as in injecting drug users and patients who were born in areas of high TB prevalence. Screening for TB in HIV seropositive patients is important both for detecting asymptomatic tuberculous infection and for recognizing patients at risk for reactivation of latent TB. We showed a high pick-up rate with 20 out of 144 patients having treatment as a result of screening.

Tuberculosis in HIV Infection

Persons with AIDS (PWAs) are 100 times more likely to develop tuberculosis (TB) than the general population. The TB incidence rates in PWAs in the US range from 4-21%, especially among intravenous drug users and Haitians. In Florida, 60% of Haitian AIDS patients also had TB compared to 2.7% of non-Haitian AIDS patients. At a hospital in London, England, 25% of PWAs also had TB and 42% of all AIDS patients at this hospital were members of racial groups with a high prevalence of TB. In developed countries, reactivation of a latent TB infection is generally what occurs in AIDS patients. The absolute number of AIDS patients with TB in these countries is low and unlikely that it will spread to non-HIV seropositive patients. On the other hand, 30-60% of adults have been infected with Mycobacterium tuberculosis in central Africa and HIV seroprevalence is also high. So many AIDS patients here can develop TB through reactivation or exogenous primary infection. This situation significantly increases the risk of TB for HIV seronegative persons. In fact, TB is 1 of the most frequent opportunistic infections in PWAs in developing countries, such as central Africa. In patients at an early stage of HIV infection, TB manifests itself classically. The clinical presentation in patients in the late stages includes fever, weight loss, malaise, productive cough accompanied with labored breathing, an atypical chest radiograph, and extrapulmonary TB. This atypical pattern often results in delays of diagnosis and treatment. Many sputum samples do not test positive for M. tuberculosis therefore if a physician suspects TB, treatment should begin immediately. Some studies demonstrate that isoniazid prophylaxis substantially decreases the incidence of TB in HIV seropositive patients in Zambia. There is no conclusive evidence of the harm or effectiveness of the BCG vaccine in HIV children and adults.

Characteristics of tuberculosis in HIV-infected patients: a case-control study.

To test the hypothesis that HIV infection can modify the clinical characteristics of tuberculosis, 65 consecutive cases of tuberculosis in HIV-seropositive patients diagnosed in Barcelona (Spain) were compared with 65 HIV-seronegative controls matched for age and sex. Thirty of the 65 cases were accepted as AIDS cases (August 1987 Centers for Disease Control criteria) only because of the tuberculosis. Among the cases 54 (83%) were parenteral drug addicts and 88% were males. The tuberculosis was pulmonary or pleural in 62 controls (96%) but in only 25 cases (39%; P less than 0.0001). Lymph nodes were involved in 25 cases (39%) and in none of the controls (P less than 0.0001). Disseminated forms of tuberculosis were present in seven cases (11%) and in no controls (P less than 0.007). Bone, joints and central nervous system involvement were also significantly (P less than 0.05) more frequent in cases. The treatment (isoniazid and rifampin for 6 months plus ethambutol and pyrazinamide during the first 2 months) was always effective. One relapse was detected after a median follow-up of 55 months in cases and none in controls after a median follow-up of 43 months. Twenty-five cases (39%) and 14 controls (22%) developed mild or severe side effects related to the treatment (P less than 0.004). In conclusion, most of the HIV-infected patients with tuberculosis were drug addicts with extrapulmonary or disseminated forms. A short course of treatment (6 or 9 months) may be enough but side effects were frequent.