HIV-TB coinfection: Clinico-epidemiological determinants at an antiretroviral therapy center in Southern India

Abstract

Background: HIV-TB (tuberculosis) coinfection has emerged as a major public health threat. Given the multifactorial enabling environment in a resource-constrained setting like India, the consequences are of epidemic proportions.

Aims: This study was aimed at identifying the clinical and epidemiological determinants underlying HIV-TB coinfection.

Settings and design: A retrospective review of patient records was done from the antiretroviral therapy center (ART) center at a district hospital in southern India between May and August 2012.

Materials and methods: Secondary data of 684 patients on ART as well as pre-ART were collected between July 2008 and June 2012 and were analyzed.

Statistical analysis: Descriptive analysis, χ(2), and Wilcoxon signed rank tests were used with SPSS version 15.0 to draw significant statistical inferences.

Results: HIV-TB coinfection was diagnosed in 18.9% with higher prevalence among males (75.3%), in the sexually active age group 31-45 years (61.3%), with less than primary education (44.15%), who were married (56.1%), laborers (42.4%), from rural backgrounds (88.2%), and having low income-earning capacity (94.4%). Transmission was predominantly through the heterosexual route. The key entry point was the integrated counseling and testing center (ICTC) (47.4%). Pulmonary tuberculosis (58.8%) was predominantly found followed by extrapulmonary tuberculosis (38.2%) and both in 3.1%. A favorable outcome was observed in 69.3% of coinfected patients with 89.2% on ART and 97.2% currently on DOTS therapy. The Wilcoxon signed-rank test found significant association between rises in CD4 counts after the 6(th)-month follow up (P < 0.05). Coinfected patients had a case fatality rate of 25%.

Conclusions: The prevalence of HIV-TB coinfection recorded in this sample was 18.86%. ICTC implemented by NACO emerged as an effective entry point, while Revised National Tuberculosis Control Program referred 1.6% (n = 11) of the patients to the ART center. Coinfection is associated with lower CD4 counts than those with HIV alone, which could translate into increased morbidity and progression of HIV to AIDS.

Keywords: ART; CD4; DOTS; HIV–TB coinfection; ICTC.

Graph 1

CD4 rise at 6 months correlated significantly to initial CD4 count (P < 0.05)