Factors associated with prevalent tuberculosis among patients receiving highly active antiretroviral therapy in a Nigerian tertiary hospital

Abstract

Background:Tuberculosis (TB) causes significant morbidity/mortality among human immunodeficiency virus-infected individuals in Africa. Reducing TB burden in the era of highly active antiretroviral therapy (HAART) is a public health priority.Aim:We determined the factors associated with prevalent TB among patients receiving HAART.Subjects and Methods:We conducted a cross-sectional study of adult patients who had received HAART for ≥12 weeks in a Nigerian tertiary hospital. Patients whose TB diagnosis predated HAART were excluded from the study. Pre-HAART data were collected from the clinic records, whereas post-HAART data were obtained through medical history, physical examination, and laboratory investigations. Standard TB screening/diagnostic algorithms as applicable in Nigeria were used. Logistic regression analysis was used to determine factors independently associated with prevalent TB.Results:about 65.8% (222/339) were women. The mean age was 41.1 (10.0) years and 23.6% (73/339) had past history of TB. The prevalence of active TB was 7.7% (26/339). Among these patients, 42.3% (11/26) had pulmonary TB, 34.6% (9/26) had disseminated TB, whereas 23.1% (6/26) had only extra-pulmonary disease. Only 45% (9/20) of patients with pulmonary involvement had positive sputum smear. Factors independently associated with prevalent TB were lower social class (adjusted odds ratio [aOR]: 31.7; 95% confidence interval [CI]: 1.1–1417.3), HAART non-adherence (aOR125.5; 95% CI: 9.6–1636.3), baseline CD4 <200cells/μl (aOR31.0; 95%CI: 1.6–590.6), previous TB (aOR13.8; 95% CI: 2.0–94.1), and current hemoglobin <10 g/dl (aOR10.3; 95% CI: 1.1–99.2).Conclusion:Factors associated with prevalent TB were a lower social class, HAART non-adherence, severe immunosuppression before HAART initiation, previous TB, and anemia post-HAART. TB case finding should be intensified in these high-risk groups.

Incidence Rates for Tuberculosis Among HIV Infected Patients in Northern Tanzania

“…Several factors have been associated with TB incidence among HIV positive individuals including limited functional status, very low CD4 count (<50 cells/μl) (53), anemia, inappropriate vaccinations, cigarette smoking, households with a family size of 3 to 4 people, a lower social class, non-adherence to drugs and severe immunosuppression (8).…”

Anemia as a risk factor for tuberculosis: a systematic review and meta-analysis

“…Of the included 17 articles, 2 (11.8%) research articles were published in years of 2005 [ 27 ] and 2011 [ 28 ] (one in each year’s) while 5 (29.4%) of them were published in the year of 2013 [ 29 , 31 , 32 , 33 , 35 ] and 1 (5.9%) of the research articles was published in the year of 2014 [ 11 ]. Nine (52.9%) of the included articles were published between 2015 and 2019 (4 (23.5%) in 2015 [ 20 , 21 , 30 , 34 ], 2 (11.8%) in 2016 [ 22 , 24 ], and 3 (17.6%) in 2019 [ 10 , 17 , 23 ]). Three of the included studies were cross-sectional studies and were conducted in South Africa [ 11 ], Cameroon [ 29 ], and Nigeria [ 24 ].…”

“…Nine (52.9%) of the included articles were published between 2015 and 2019 (4 (23.5%) in 2015 [ 20 , 21 , 30 , 34 ], 2 (11.8%) in 2016 [ 22 , 24 ], and 3 (17.6%) in 2019 [ 10 , 17 , 23 ]). Three of the included studies were cross-sectional studies and were conducted in South Africa [ 11 ], Cameroon [ 29 ], and Nigeria [ 24 ]. The other 2 studies were case-control studies conducted in three West Africa countries [ 27 ] and Ethiopia [ 28 ].…”

“…In the current systematic review and meta-analysis, majority of the included studies showed that anemia was a higher predicator of TB [ 10 , 11 , 17 , 22 , 27 – 29 , 30 , 31 ]. However, some studies showed that anemia was not the risk of TB [ 20 , 24 , 33 ]. The reason for discrepancy might be different in sample size, study design, diagnostic method, and geographical location.…”

“…Accordingly, some studies showed that anemia is risk for TB [21][22][23]. In contrast, others showed that anemia is not the risk of development of TB [20,24]. These contradict findings and the absence of systemic review and meta-analysis conducted about the risk of contracting TB among anemic patients; motivate the authors to conduct this systemic review and meta-analysis.…”