Proportion and determinants of tuberculosis among human immunodeficiency virus-positive patients attending the antiretroviral therapy center attached to a Medical College in South India

Abstract

Background:The human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) pandemic has caused a re-emergence of tuberculosis (TB). In persons infected with both HIV and TB, the lifetime risk of developing TB disease is 50–70% compared to 10% in HIV-negative individuals. India has world's 3rd highest HIV burden and is also one of the countries endemic for TB, so the country faces a dual epidemic of HIV and TB.Objectives:To find out the proportion and determinants of TB in HIV-positive subjects.Subjects and Methods:This study was undertaken at the ART center from June 01, 2012, to May 31, 2013. HIV-positive subjects aged above 15 years who had been on antiretroviral therapy (ART) for more than 6 months were included in the study. Nonprobability purposive sampling was adopted. A predesigned semi-structured questionnaire was used to obtain data.Results:A total of 536 HIV-positive people were interviewed, 58.8% of whom were males, 79.1% were Hindu, 61.0% had up to high school education, and 57% were unskilled laborers. About 63% were married, 40% were from the upper lower class, and 60% were from urban areas. For the majority (89.1%), the probable mode of transmission of HIV was by the heterosexual route. TB co-infection was present in 38.4% subjects. The most common form of TB was extra-pulmonary in subjects on antituberculous treatment (47.3%) and among old cases (57.6%). On bivariate analysis, 136 (42.4%) married subjects and those from rural areas were more commonly affected by TB compared to subjects who were unmarried and from urban areas with odds ratio (OR): 1.555, confidence interval (CI): 1.077–2.246 and OR: 1.523, CI: 1.061–2.185, respectively. The proportion of TB was high among subjects who lived in overcrowded houses 130 (44.2%), and who had a habit of alcohol use compared to others with OR: 1.731, CI: 1.734–2.179 and OR: 1.524, CI: 1.045–2.223, respectively. Logistic regression analysis showed that TB among people living with HIV/AIDS was highest in persons living in overcrowded houses (OR: 1.706, CI: 1.185–2.458) and those who consumed alcohol (OR: 1.605, CI: 1.090–2.362).Conclusions:Demographic factors like male gender, middle age, living in the rural areas, consumption of alcohol, and living in overcrowded houses were found with a higher proportion of TB. The use of highly active ART appeared to progressively decrease but did not completely eliminate the risk of TB.

Determinants of Tuberculosis Among HIV Infected Adults in Horro Guduru Wollega Zone, West Ethiopia: A Facility-Based Case-Control Study

“…In this study, those who ever use alcohol were more likely to get TB co-infection in adults. This finding is similar with multicenter case control study done in North West Ethiopia, Nigeria, Amhara region (Ethiopia), India (6,32,43,44). This could be explained by social mixing pattern which may increase the risk of exposure to active infectious TB disease in areas where alcohols mostly available like bars where people drinks in group (45), the other possible reason was alcohol consumption reduces the immune response in human and increases the risk for TB/HIV co-infection (2).Alcohol abuse is an important cause of immunological impairment (7).…”

Predictors of tuberculosis infection among adults visiting anti-retroviral treatment center in east and west Gojjam, northwest, Ethiopia, 2017

“…Our ndings show that alcohol drinkers were predictors of TB infection among HIV positive patients in this study. This was consistent with previous studies conducted in South India [18], West Africa [19] and Amhara Region [20]. Nevertheless, in contrast to the study conducted in Gambia [21] alcohol use is not associated with TB infection, this is because of socio-demography, sampling technique difference and sample size.…”

Predictors of tuberculosis infection among adults visiting anti-retroviral treatment center in east and west Gojjam, northwest, Ethiopia, 2017

“…This study was consistent with previous studies conducted in South India [23], West Africa [26] and Amhara Region [39]. Alcohol is able to change the immune response and long-term alcohol consumers have been shown to weaken immunity (14), but in contrast to the study conducted in Gambia [27] alcohol use is not associated with TB infection.…”

“…Low body mass index (LBMI<18.5 kg/ m2) was associated with increased TB infection; this is parallel to a study done in South India [23], Croatia [24], South Africa [29] and south central Ethiopia [38].…”