Clinical and laboratory profile of TB-HIV co-infected patients with relation to CD4 counts in a tertiary care hospital

Abstract

Background: Tuberculosis is the commonest opportunistic infection in HIV infected individuals. Global TB report by WHO estimates 0.4 million deaths by TB in 2014 in HIV infected individuals. The clinical profile of TB in HIV infected individuals are variable from region to region based upon the prevalence of HIV in the region. The aim of the present study was to determine the clinical profile of tuberculosis and the distribution of pulmonary and extra pulmonary tuberculosis in HIV infected individuals with relation to their CD4 counts. Methods: A prospective cross sectional study was done for a period of two years from January 2013 to December 2014 at a tertiary care hospital in south India. Sputum samples were screened for Mycobacterium tuberculosis from 150 HIV seropositive individuals in the study. AFB positive smears were graded as per RNTCP guidelines. Clinical profiles of the cases in the study were noted and the Chest X ray, ultrasonogram and other relevant investigations were performed in smear negative individuals to diagnose pulmonary and extra pulmonary tuberculosis. Results: In our study 26-35 years was the major age group (37.33%) with male preponderance. Heterosexual mode of acquisition was common (88.67%) and in 6% the mode was unknown. Fever was the most common symptom (100%) followed by cough with expectoration in 84% of HIV-TB co-infected cases.44% of cases were smear positive for AFB bacilli and 57.58% were graded 3+, 65.33% of cases had pulmonary infiltrates on chest X-ray followed by 16% with effusion. Lymphadenopathy was the most common extra pulmonary involvement seen in 28.67% of cases followed by 14.67% with meningeal involvement. Overall in the study isolated pulmonary tuberculosis was seen in 43 (28.67%) patients, isolated EPTB was seen in 13(8.67%) patients and both were seen in 84 (56%) patients. In all cases of EPTB CD4 cell counts were <200cells/µl. Conclusions: To conclude HIV more commonly affects the economically productive age group with more males than females. Sputum positivity depends upon the stage of HIV infection. Lymphadenopathy is more common form of EPTB and diagnosis can be made by FNAC and Histopathological examination.