STUDY OF PREVALENCE OF HIV INFECTION AND IT’S CLINICAL PROFILE AMONG TUBERCULOSIS PATIENTS AND NON-TUBERCULOSIS PATIENTS – CASE CONTROL STUDY
DR.S.ABBAS ALI
MD, DNB,MNAMS
FCGP, FPC (cardiology)
PGDHSc (Ultrasonography)
PGDHSc (Echocardiogram)
M : 9412178773
Email: dr.abbas1968@gmail.com

ABSTRACT
INTRODUCTION: Tuberculosis is a major opportunistic infection in HIV patients’ world wide. Many patients were being treated for tuberculosis without knowledge of the presence or absence of concurrent HIV infection. Relapse rate is high in HIV-TB, which may be due to re-infections rather than true relapse of TB. Detection of HIV status in a TB patient is critical from both patient and public health perspectives and for holistic management of HIV-TBpatients
Objectives: To determine the prevalence of HIV infection and its clinical profile among tuberculosis patients (Cases) and Non-TB patients (Controls)
Methods: A case-control study study was conducted at SKM hospital, Mathura, Uttar Pradesh during the period September 2009 to February 2011. 252 proven Tuberculosis patients as cases and 252 non-tuberculosis patients (having similar clinical features like TB) as controls selected stratified random sampling method
Results: Out of 252 tuberculosis patients 26 were HIV seropositive and none was positive in Non-TB patients. The percentage of prevalence in TB patients was 10.3%. The prevalence in males 13.2% (19/143) and in females, 6.4% (7/252), 12 (46.15%) were married and 14 (53.85%) were singles, 17 (65.38%) patients were Hindus and 9 (34.62%) were Muslims. 14 (53.85%) patients were from rural areas and 12 (46.15%) patients were from urban areas. 96.2% HIV –TB patients has income below 10000/Rs and all most all HIV – TB patients has heterosexual sexual behavior and not used protective measures during unprotected extramarital sex. The most peculiar clinical features of HIV seropositive TB patients of this study were chronic diarrhea (73%) aphthous ulceration (92.3%), pain in abdomen (38.4%) oral candidiasis (26%) lymphadenopathy (39.8%).
Conclusions: HIV seroprevalence was higher among TB patients and calls for routine HIV screening and counseling of TB suspects for holistic management. Despite the synergy between the human immunodeficiency virus (HIV) and tuberculosis (TB) epidemics, the public health responses have largely been separate. Intensive efforts and early diagnosis of HIV infection among tuberculosis patients was crucial for holistic management of HIV-TB patients. With this study screening of HIV antibodies in TB patients adds one more classification, which will be more helpful in predicting prognosis of disease.


Classification
TB: it is assumed all TB cases (pulmonary and extra-pulmonary) were curable. It can be easily diagnosed by AFB sputum and x-ray chest PA View
Resistant TB: it includes MDR-TB and XDR-TB, which can be easily predicted with the help of previous prescriptions. Management of Resistant TB was beyond the reach of family physician and can be referred to higher centre.
HIV-TB: Can be easily diagnosed in TB patients by rapid card tests. Beside ATT it requires services of nearest ART centre.
Knowledge of HIV status in a TB patient is critical from both patient and public health perspectives. In those patients who test seropositive for HIV, better care can be provided in the form of effective combined antitubercular (ATT) therapy and antiretroviral treatment. ATT was alone insufficient for the treatment of HIV seropositive TB and it was observed during this study that curative outcome was more with addition of antiretroviral therapy. If a HIV-positive TB patient on ATT worsens or fails to improve with therapy, the possibility of other co-existing opportunistic infections or immune reconstitution syndrome should be considered. Knowledge of a person's HIV serostatus also provides the opportunity to administer prophylaxis for opportunistic infections and thereby reduces morbidity and mortality. The spouse and relatives of HIV-seropositve patients may also be counseled on HIV infection and its modes of transmission and prognosis, preventing the spread of infection. Spouses may be educated on safe sex practices and may be offered testing themselves.