[Impact of HIV infection on the evolution of tuberculosis among adult patients in Yaounde, Cameroon]

Abstract

Background: Tuberculosis and human immunodeficiency virus infection are two major public health problems in sub-Saharan Africa. The aim of this study was to determine the prevalence of HIV infection in all clinical forms of TB and investigate the effects of HIV status on the evolution of tuberculosis.

Patients and methods: This is a retrospective study relating to the 1647 adult's tuberculous patients, HIV status was known in 1419 cases which were followed-up at the diagnosis and treatment center for tuberculosis of the Yaounde Jamot Hospital in 2009.

Results: The prevalence of HIV infection was of 35% as a whole and 31.3%, 43.3% and 47.7% respectively for the smear positive pulmonary tuberculosis, smear negative pulmonary tuberculosis and extrapulmonary tuberculosis. Compared to HIV negative patients, HIV positive patients were older (36years versus 30years, P<0.0001) and included more women (57.1% versus 37.3%, P=0.001). The treatment success rate was 79% in HIV negative patients and 69% among HIV positive ones. The equivalent for mortality rate was respectively 1.9% and 10.5% (both P<0.001). In HIV positive patients, the death rate was 3.7% among those with CD4 above 200/mm(3) and 13% among those with CD4 below 200/mm(3) (P<0.02).

Conclusions: The HIV infection is frequent among adult patients with tuberculosis in this setting, particularly among patients with smear negative pulmonary tuberculosis or extrapulmonary tuberculosis. It is associated with a high mortality rate especially on patient with severe immunodeficiency in spite of the antiretroviral treatment and prophylaxis with the cotrimoxazole.