CORELATION OF CD4 COUNT WITH THE CLINICORADIOLOGICAL AND MICROBIOLOGICAL PROFILE IN PATIENTS WITH HIV AND PULMONARY TUBERCULOSIS COINFECTION
Journal Title: PARIPEX-Indian Journal of Research - Year 2015, Vol 4, Issue 2
Abstract
Currently, about 33 million people are HIV-infected, and almost one-third are also infected with TB.[ 1,2] It is an established fact that tuberculosis is one of the commonest opportunistic infections in patients with HIV infection and can develop at any stage of the disease.[3] In fact, the risk of developing TB in HIV infected patients has been estimated to be 5 – 15%/year (5 – 10% during life time of non HIV-1 infected patients).[4] Again, during the course of tuberculosis, the HIV virus burden and heterogeneity increases.[5,6] The occurrence of TB does not correlate with CD4 counts, although TB is more commonly seen in severely immuno-compromised patients.[7] HIV induced immunosuppression affects the clinical presentation of TB and it is also noted that in those with CD4 counts of ≤200, there were 6.0% of patients with drug resistance TB.[7] Among the various factors related to TB drug resistance severe immunodeficiency plays an important role.[7] Cavitating lesions are rarely seen in patients with a CD4 counts < 200/mm [8,9] instead atypical features like lower lobe involvement with diffuse infection are seen more commonly. Although Mantoux test positivity for TB diagnosis depends on the immune status of an individual, several studies have shown that Mantoux test is not helpful to diagnose TB in those with late HIV disease [8,10]. Aims & Objectives: To determine what influence the CD4 cell count has on the tuberculin skin sensitivity, the appearance of the chest radiograph, on the likelihood of positive acid-fast smears, presence of drug resistance, and on the presence of disseminated infection in patients with HIV and pulmonary tuberculosis coinfection. Method & Materials: The present study is a prospective observational one which was done on 84 HIV positive patients microbiologically radiologically and clinically diagnosed with Pulmonary Tuberculosis in Dr. S. N. Medical College, Jodhpur. Their sputum samples were sent to the IRL [Kamla Nehru State TB Demonstration & Training Centre, Jawaharlal Nehru Medical College] in Ajmer for mycobacterial culture and later Drug Sensitivity testing for four ATT drugs- H, R, S and E. Those HIV seropositive patients of all ages [confirmed at the Voluntary Counseling and Testing Center (VCTC), Department of Microbiology, Dr. S.N.Medical College, using three different methods ( ELISA / rapid tests / simple tests) as per National AIDS Control Organization (NACO) guidelines][11] were included in the study who were either microbiologically proved Sputum positive for AFB. [ Sputum smears for acid fast bacilli [AFB] was examined at our DOTS centre, Kamla Nehru Chest Hospital.] or whose Sputum was negative for AFB but their clinical symptoms and Chest radiography is highly suggestive of Pulmonary Tuberculosis. Both fresh and re-treatment cases of Pulmonary TB were included. All clinical stages of HIV infection according to the WHO classification were included. Patients suffering from other immunosuppressive conditions like Diabetes Mellitus, Primary immune deficiencies, Extra pulmonary TB or on long term steroids/ immunosuppressive drugs were excluded from the study. CD4 cell immune-phenotyping was performed using a BD FACS count system
Authors and Affiliations
Dr. Sivaresmi Unnithan MD, Dr. P. D. Motiani MD
Keywords
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