Tuberculosis, incarceration, and HIV at a crossroads in Guyana

The objective of this study was to describe the sociodemographic and clinical characteristics of patients dually infected with HIV and tuberculosis (TB) in Guyana.

The data for this study were obtained as part of a related project conducted to determine the prevalence of diabetes mellitus among TB patients in Guyana. From April to June 2006, a convenience sample of 100 patients was selected from those attending three TB clinics in Guyana and a structured questionnaire was used to collect relevant sociodemographic and risk factor data. The sociodemographic and clinical data of HIV-negative and HIV-positive patients with pulmonary TB were compared. Logistic regression was conducted to determine independent relationships between sociodemographic and clinical features.

One hundred TB patients were considered for enrolment in the study, but since the HIV status was known for only 77 persons, these were included in the analysis. Thirty-one of the 77 (40.3%) were HIV-positive. Seventy-two of the 77 (93.5%) patients had pulmonary TB, 28 of whom were HIV-positive; the other five had extrapulmonary TB, three of whom were dually infected. Several social factors and clinical manifestations including incarceration at the time of TB diagnosis (p=0.01), cigarette smoking (p=0.05), homelessness (p=0.07), chest pain (p=0.001), hemoptysis (p=0.02), cough (p=0.08), and being acid-fast bacillus (AFB) sputum smear-positive (p=0.06) were associated with HIV-negative pulmonary TB. In the logistic regression model, HIV-negative TB patients demonstrated higher frequencies of complaints of chest pain (odds ratio (OR) 34.48, 95% confidence interval (CI) 4.35-250) and were more likely to be AFB sputum smear-positive (OR 11.97, 95% CI 1.91-74.76) than HIV-positive TB patients.

Guyana is faced with a particularly high burden of HIV infection among TB patients. Given the impact of HIV on the clinical presentation of TB, physicians managing HIV patients should demonstrate a high level of suspicion for TB among these patients. Incarceration is a strong correlate of TB, overall.