Manifestations of tuberculosis in HIV/AIDS patients and its relationship with CD4 count

Abstract

Background:HIV/AIDS pandemic is responsible for the resurgence of TB worldwide, resulting in increased morbidity and mortality. HIV and Mycobacterium tuberculosis have a synergistic interaction; each propagates progression of the other. Coinfection with HIV infection leads to difficulties in both the diagnosis and treatment of tuberculosis, increase risk of death, treatment failure and relapse.Objective:The aim of the present study is to study the clinical, radiological profile of pulmonary and extrapulmonary tuberculosis (EPTB) in HIV-seropositive patients and their relationship to CD4 counts.Materials and Methods:It was a prospective study conducted over a period of 1 year in the department of medicine, Indira Gandhi Medical College, Shimla. We examined 87 HIV-infected patients with associated tuberculosis recruited from the department of medicine and antiretroviral center and were subjected to thorough clinical examination, X-ray chest, tuberculin testing and sputum examination for AFB and necessary relevant investigations for EPTB.Results:Most common affected age group was 31-40 years. EPTB is the commonest form of TB in our study detected in 65 patients. Commonest EPTB was CNS tuberculosis. Disseminated tuberculosis was only found in patient with CD4 count less than 200/cmm. Majority of lymph node TB was diagnosed by fine needle aspiration cytology (FNAC) examination. All patients with AFB-positive lymph node had CD4 count below 200/cum.Conclusions:The results of this study provide information regarding the various forms of TB and their presentation in HIV-infected persons. Early diagnosis of tuberculosis and prompt institution of antitubercular treatment (ATT) reduces mortality and morbidity significantly. In resource-poor areas, the diagnosis can be established with cytological/biochemical analysis of fluid, histopathological examination and ZN staining of tissue coupled with radiological features and response to ATT. Therefore, adequate knowledge of the manifestations of tuberculosis in HIV-infected patients is absolutely necessary for optimal management and to reduce mortality and morbidity.

Smear positive extra pulmonary tuberculosis disease at University of Gondar Hospital, Northwest Ethiopia

“…Previously, age was reported as an independent risk factor for EPTB infection in high-burden countries [26,32,33]. This is consistent with other studies in San Francisco, Saudi Arabia, India and Tanzania which showed that high prevalence of EPTB among productive age groups [26,28,30,34]. Most of tuberculosis cases in this population might be largely related to ongoing tuberculosis transmission, given that the associated age group (31–40 years) is known as the most unstable and high risk group for TB transmission.…”

“…Male patients were more likely to present with extra pulmonary tuberculosis than females (58.8% versus 41.2%). This is supported by other reports from India, (65.6% versus 34.4%), Malatya/Turkey, (53.4% versus 46.6%) and Nigeria, (64.6 % versus 35.4%) [21,28,29]. However, there are contradictory reports on the EPTB prevalence among male and female patients.…”

Tuberculous Meningitis in Patients Living with HIV

“…Previous studies also reported results of severe immune suppression with median CD4 count reaching sixteen to fourteen [7,23,39]. This finding contrasts a previous study conducted by Kingkaew et al, which founded that 71, 8% of HIV infected patients with TBM had CD4 lymphocyte counts < 100 [40]. Anti-TB treatment should be started once TBM is suspected because of the associated high case fatality [3,7].…”

“…Higher rates of mortality have been described in other study conducted in Cameroon. Studies from Brazil and China reported rates of mortality at 29% [40]. In HIV infected patients, a lower CD4 cell counts [3,23], focal signs and altered consciousness on admission, were found to be a factor associated with poor prognosis [47].…”

Tuberculosis Incidence and Mortality Rates Among People Living with HIV Receiving Antiretroviral Therapy at the Buea Regional Hospital: A Seven Year Retrospective Study

“…[4,5] Therefore, the HIV/AIDS pandemic is responsible for the resurgence of TB worldwide, resulting in increased morbidity and mortality. [6,7] Even in antiretroviral (ART) treated patients, TB is the most common presenting illness. [8,9] HIV infected patients on HAART have a tuberculosis incidence rate of 5.4 cases/100 person-years, approximately 10-15 times higher than tuberculosis incidence rates in HIV-negative patients in the same community.…”