Title: Prevalence of pulmonary and extra-pulmonary tuberculosis among HIV patients receiving ART at tertiary care centre
Authors: Dr Hemant Kumar, Dr Utkarsh Kumar Srivastava, Dr Manoj Kumar Pandey, Dr Ajay Kumar Verma, Dr Rishabh Chaudhary, Dr Arvind Kumar Singh
DOI: https://dx.doi.org/10.18535/jmscr/v8i1.122
Abstract
Introduction
India has the world’s highest burden of tuberculosis (TB) and third largest number of people living with HIV in the world; it also ranks third in the world for HIV-associated TB. While TB is endemic across India, the HIV epidemic is concentrated in six out of all states and union territories in the country: Andhra Pradesh, Karnataka, Maharashtra, Tamil Nadu, Manipur and Nagaland. More than 75% patients with HIV-associated TB are from these six states mentioned above. About 87,000 people in India are estimated to be HIV-TB co-infected in 2017, with the national average for HIV prevalence among incident TB cases at 5%(1). It is recognized that HIV and TB make for a fatal combination with extremely high death rates (15–18%) reported among HIV infected TB cases notified under the Revised National Tuberculosis Control Programme (RNTCP). Further even among cured TB cases with HIV infection, the risk of recurrent TB either drug sensitive or drug resistant are quite high. Overall, TB is estimated to cause about 25% of all deaths among PLHIV in India(2). People with HIV and TB infection are much more likely to develop active TB. Each case of TB—HIV co-infection and/or drug-resistant tuberculosis severely aggravates the global TB situation. TB is a leading cause of death in HIV-infected persons, and HIV infection is the most potent risk factor for developing active TB disease from a latent TB infection(3). In contrast to western countries, where Pneumocystis jiroveci pneumonia was the commonest HIV-associated illness(4), in developing countries TB is the most common life-threatening opportunistic infection (OI) in patients with HIV/AIDS with about 25 to 65 per cent patients with HIV/AIDS having tuberculosis of any organ(5). Clinical presentation of TB in HIV-infected individuals depends on the level of immunosuppression resulting from HIV infection. In patients with relatively intact immune function (CD4+ count > 200/mm3), pulmonary TB (PTB) is more frequently seen and as immunosuppression progresses, EPTB becomes increasingly common(6).
