Incidence of Active Tuberculosis Among Human Immunodeficiency Virus (HIV)-Positive Patients and Evaluation of Their Responses to Usual Anti-Tuberculosis Medications in Shiraz, South West of Iran
Abstract
Background: Human Immunodeficiency Virus (HIV) makes infected cases prone to opportunistic infections like Tuberculosis (TB) due to impaired immunity of the body, especially Multi Drug Resistant (MDR) ones which are a major concern. With HIV outbreak starting late in the 20th century, the international health community is observing a huge rise in the incidence of this complex disease. Herein, we estimated the incidence of TB among HIV-positive individuals and their responses to anti-tuberculosis medications in Shiraz, Southwest of Iran. Materials and Methods: 840 HIV-positive patients were included in this cross-sectional study. During the first examination CD4+ count and PPD test was obtained, patients were checked for other symptoms too. Patients, if diagnosed with TB, received proper medication. If therapy failed, second-line therapy was prescribed for them. Type of resistance was studied and recorded. Patients continued their routine anti-viral therapy during the study. Results: Of 840 participants, 29 were diagnosed with Active TB (3.4%), 76% of them were diagnosed with PCR and culture and other with acid fast. Males were the majority of TB positives (82.8%). Most patients suffering from TB had CD4+ count lower than 200 (55.1%); 17.2% of the cases were MDR-TB. Conclusion: Low CD4+ count makes the patient vulnerable to TB. It is necessary to maintain patient’s immunity in order to treat and prevent tuberculosis; so, anti-viral therapies still play important roles in preventing TB in HIV-positive patients.[GMJ.2015;4(2):115-20]References
Sepkowitz KA. AIDS--the first 20 years. The New England journal of medicine. 2001;344(23):1764-72.
Alimonti JB, Ball TB, Fowke KR. Mechanisms of CD4+ T lymphocyte cell death in human immunodeficiency virus infection and AIDS. The Journal of general virology. 2003;84(Pt 7):1649-61.
Lewden C, Salmon D, Morlat P, Bevilacqua S, Jougla E, Bonnet F, et al. Causes of death among human immunodeficiency virus (HIV)-infected adults in the era of potent antiretroviral therapy: emerging role of hepatitis and cancers, persistent role of AIDS. International journal of epidemiology. 2005;34(1):121-30.
Galvin SR, Cohen MS. The role of sexually transmitted diseases in HIV transmission. Nature reviews Microbiology. 2004;2(1):33-42.
Corbett EL, Watt CJ, Walker N, Maher D, Williams BG, Raviglione MC, et al. The growing burden of tuberculosis: global trends and interactions with the HIV epidemic. Archives of internal medicine. 2003;163(9):1009-21.
Dolin PJ, Raviglione MC, Kochi A. Global tuberculosis incidence and mortality during 1990-2000. Bulletin of the World Health Organization. 1994;72(2):213-20.
Jesudas CD, Thangakunam B. Tuberculosis risk in health care workers. The Indian journal of chest diseases & allied sciences. 2013;55(3):149-54.
Dye C, Watt CJ, Bleed DM, Hosseini SM, Raviglione MC. Evolution of tuberculosis control and prospects for reducing tuberculosis incidence, prevalence, and deaths globally. JAMA : the journal of the American Medical Association. 2005;293(22):2767-75.
McIlleron H, Meintjes G, Burman WJ, Maartens G. Complications of antiretroviral therapy in patients with tuberculosis: drug interactions, toxicity, and immune reconstitution inflammatory syndrome. The Journal of infectious diseases. 2007;196 Suppl 1:S63-75.
Dalton T, Cegielski P, Akksilp S, Asencios L, Campos Caoili J, Cho SN, et al. Prevalence of and risk factors for resistance to second-line drugs in people with multidrug-resistant tuberculosis in eight countries: a prospective cohort study. Lancet. 2012;380(9851):1406-17.
Zignol M, Hosseini MS, Wright A, Weezenbeek CL, Nunn P, Watt CJ, et al. Global incidence of multidrug-resistant tuberculosis. The Journal of infectious diseases. 2006;194(4):479-85.
Raviglione MC, Smith IM. XDR tuberculosis--implications for global public health. The New England journal of medicine. 2007;356(7):656-9.
Singh A. XDR-TB: Indian perspective. The European respiratory journal. 2007;30(1):178-9.
Masjedi MR, Farnia P, Sorooch S, Pooramiri MV, Mansoori SD, Zarifi AZ, et al. Extensively drug-resistant tuberculosis: 2 years of surveillance in Iran. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. 2006;43(7):841-7.
Farnia P, Masjedi MR, Mirsaeidi M, Mohammadi F, Jallaledin G, Vincent V, et al. Prevalence of Haarlem I and Beijing types of Mycobacterium tuberculosis strains in Iranian and Afghan MDR-TB patients. The Journal of infection. 2006;53(5):331-6.
Bucher HC, Griffith LE, Guyatt GH, Sudre P, Naef M, Sendi P, et al. Isoniazid prophylaxis for tuberculosis in HIV infection: a meta-analysis of randomized controlled trials. AIDS (London, England). 1999;13(4):501-7.
Khazaei HA, Rezaei N, Bagheri GR, Dankoub MA, Shahryari K, Tahai A, et al. Epidemiology of tuberculosis in the Southeastern Iran. European journal of epidemiology. 2005;20(10):879-83.
Haghdoost AA ME, Mirzazadeh A , Navadeh S , Feizzadeh A , Fahimfar N , et al. Modelling of HIV/AIDS in Iran up to 2014. J AIDS HIV Res. 2011;3(12):231-9.
Ewer K, Deeks J, Alvarez L, Bryant G, Waller S, Andersen P, et al. Comparison of T-cell-based assay with tuberculin skin test for diagnosis of Mycobacterium tuberculosis infection in a school tuberculosis outbreak. Lancet. 2003;361(9364):1168-73.
Davarpanah M, Rafiee G, Mehrabani D. The Prevalence of M. Tuberculosis Infection and Disease in HIV Positive Individuals in Shiraz, Southern Iran. Iran Red Crescent Med J. 2009;11(2):192-202.
Kall MM, Coyne KM, Garrett NJ, Boyd AE, Ashcroft AT, Reeves I, et al. Latent and subclinical tuberculosis in HIV infected patients: a cross-sectional study. BMC infectious diseases. 2012;12:107.
Brock I, Ruhwald M, Lundgren B, Westh H, Mathiesen LR, Ravn P. Latent tuberculosis in HIV positive, diagnosed by the M. tuberculosis specific interferon-gamma test. Respiratory research. 2006;7:56.
Giri PA, Deshpande JD, Phalke DB. Prevalence of Pulmonary Tuberculosis Among HIV Positive Patients Attending Antiretroviral Therapy Clinic. North American journal of medical sciences. 2013;5(6):367-70.
Pilheu JA, De Salvo MC, Gonzalez J, Rey D, Elias MC, Ruppi MC. CD4+ T-lymphocytopenia in severe pulmonary tuberculosis without evidence of human immunodeficiency virus infection. The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease. 1997;1(5):422-6.
Stephen D. Lawna,b, Motasim Badria and Robin Wooda. Tuberculosis among HIV-infected patients receiving HAART: long-term incidence and risk factors in a South African cohort. AIDS 2005, 19:2109–2116.
Lawn SD, Badri M, Wood R. Tuberculosis among HIV-infected patients receiving HAART: long term incidence and risk factors in a South African cohort. AIDS (London, England). 2005;19(18):2109-16.
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