A CLINICAL STUDY ON HIV-TB CO-INFECTION
Journal Title: Journal of Evolution of Medical and Dental Sciences - Year 2018, Vol 7, Issue 31
Abstract
BACKGROUND Tuberculosis has been a major public health problem worldwide for centuries. It is one of the common opportunistic infections in HIV infected individuals and is well known that it spreads via respiratory tract, can be treated effectively and if proper precaution is taken even transmission can be prevented. HIV is driving the TB epidemic in many countries including India. In countries with high HIV prevalence, TB has high morbidity and mortality. Extrapulmonary and smear-negative pulmonary cases are more in number and at the same time difficult to diagnose. Also, drug toxicity is high, and outcome is poor, partly due to coexistence of other HIV related infections. The risk of recurrence is higher. Aims- The study was designed to analyse the clinical profile and manifestation of HIV-TB co-infection and its relationship with CD4 count and to evaluate usefulness of various investigatory modalities in making a diagnosis, assess the response to treatment and to find out the incidence of MDR-TB. MATERIALS AND METHODS This was an observational study. A total of 101 patients diagnosed to have HIV-TB co-infection were selected for the study. The patients who were selected for the study were evaluated in detail clinically and with laboratory investigations. The investigations were used as a part of minimal diagnostic work-up needed to confirm the diagnosis of HIV-TB co-infection and were individualised for every patient. RESULTS Major symptoms included weight loss, fever, anorexia, tiredness, cough, sputum, headache, night sweats, dyspnoea, haemoptysis and swelling. Out of 101 cases, 25 had isolated pulmonary involvement, 49 had both pulmonary and extrapulmonary involvement and 27 had extrapulmonary involvement. Isolated pulmonary involvement occurred in 25% HIV-TB co-infection. Though significant weight loss was seen in HIV infection, accelerated weight loss of more than 10% in one-month favoured tuberculosis. Dissemination was common in HIV-TB co-infection and it occurred at low CD4 counts. There was no statistical correlation between the manifestation of Tuberculosis and the CD4 count. IRIS occurred in patients with low CD4 counts when started on HAART. Disseminated TB and miliary TB were observed below CD4 200. Imaging had an important role in the work-up of TB and some invasive procedures could be avoided because of it. 55% patients had slow response to treatment (ATT and HAART). Anti-TB drug resistance was proved in 5% cases and 3% turned out to be MDR-TB. CONCLUSION Isolated pulmonary involvement occurred in 25% HIV-TB co-infection. Extrapulmonary involvement occurred in around 75%. There was no statistical correlation between the manifestation of Tuberculosis and the CD4 count. Dissemination is common in HIV-TB co-infection and it occurs at low CD4 counts. There was significant observation that disseminated TB and miliary TB were observed below CD4 200. Even if chest x-ray is normal, a sputum AFB and AFB culture is ideal if facilities are available. Moreover, drug resistant strains can be picked up in patients with poor response characteristics. Repeated smear for AFB should be done in patients started on empirical ATT and culture may be sent in those with strong clinical suspicion. Imaging, especially ultrasound in working up cases of PUO, in HIV and following up patients with HIV-TB co-infection is more rewarding in a resource limited setting than doing complex invasive investigations or waiting for other invasive procedures. Routine AFB stain may be done on smears of lymph node aspirates and histopathology slides, as this will identify more number of TB. Flare up of TB as IRIS may be anticipated in those patients with low CD4 was started on HAART. There was no significant correlation between low CD4 count and slow response to treatment. Further studies are needed to study the poor response characteristics including nutrition and immunity.
Authors and Affiliations
Sheela Mathew, Sandeep Sandeep
Keywords
Related Articles
- EP ID EP541016
- DOI 10.14260/jemds/2018/786
- Views 78
- Downloads 0
FUNCTIONAL ASSESSMENT OF FREE RADIAL ARTERY FOREARM FLAP AFTER TONGUE RECONSTRUCTION FOLLOWING HEMIGLOSSECTOMY IN A TERTIARY CARE CENTRE OF CENTRAL INDIA
BACKGROUND Primary closure following oncosurgical resection of ca. tongue has been found to compromise tongue function in regard to speech and swallowing very badly. In contras,t reconstruction of tongue with free radial...
INTRATHECAL PRESERVATIVE-FREE KETAMINE WITH BUPIVACAINE IN COMPARISON WITH BUPIVACAINE ALONE FOR LOWER LIMB AND LOWER ABDOMINAL SURGERIES- A CLINICAL STUDY
BACKGROUND Pain relief is a basic human right and failure to relieve pain is morally and ethically unacceptable. The concept of postoperative pain relief and its utilisation has improved dramatically over recent years. I...
PROPHYLACTIC TENSION SUTURING IN LAPAROTOMIES FOR GROSS PERITONITIS- A DESCRIPTIVE STUDY
BACKGROUND Burst abdomen is a complication associated with much morbidity and mortality, postoperative to laparotomies. Any measure undertaken to prevent it is laudable and to be followed. There have been many studies as...
PYODERMA GANGRENOSUM COMPLICATING A SKIN GRAFT FOR BURNS
This is a rare presentation of pyoderma gangrenosum complicating a skin graft for burns.
SENSORY NERVE CONDUCTION VELOCITY IN SUBJECTS WITH IRON-DEFICIENCY ANAEMIA
BACKGROUND The predominant cause of anaemia in the general population is iron-deficiency anaemia, but there are little data about the peripheral nerve sensory function in subjects with iron-deficiency anaemia....