HIV and tuberculosis: partners in crime
Janak K Maniar1, Ratnakar R Kamath, Sundhiya Mandalia
1Department of Infectious Diseases, Jaslok Hospital and Research Centre, Mumbai, India, and Department of Medicine, Imperial College London, UK. jkmaniar@vsnl.com
Background:
Tuberculosis is the commonest infection detected in HIV-infected individuals worldwide.
Aim:
The aim of this study is to describe the clinical, bacteriologic and radiological spectrum of tuberculosis (TB) in the setting of human immunodeficiency virus (HIV) infection in a tertiary care centre in Mumbai.
Methods:
A total of 8640 HIV-infected individuals were screened for tuberculosis routinely from January 1998 to December 2003, using clinical examination, chest X-ray and abdominal ultrasonography, sputum smears for acid-fast bacilli (AFB) and culture on Lowenstein-Jensen medium.
Results:
TB was detected in 8078 (93.5%) patients of whom 3393 (42%) had pulmonary, 3514 (43.5%) had extrapulmonary TB and 1171 (14.5%) had disseminated disease. One thousand two hundred thirty eight patients (36.5%) showed AFB in sputum, while 1154 (34%) showed growth on culture medium and 4174 had radiographic involvement. In 781 (67%) individuals disseminated disease coexisted with pulmonary involvement. All 8078 coinfected patients were treated with anti-TB therapy (ATT), of whom 6422 patients (79.5%) showed one or more adverse events. Gastritis was the commonest complaint followed by hepatitis and skin rashes. ATT resistance was detected in 482 individuals.
Conclusion:
Tuberculosis is the commonest opportunistic infection (OI) in HIV positive patients in India, showing a higher prevalence of extrapulmonary and disseminated TB and adverse events due to ATT. Early recognition of concurrent OIs and their adequate treatment and prophylaxis is essential.
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