Clinical Profile of Pulmonary Tuberculosis in Patients with HIV Infection
Clinical Profile of Pulmonary Tuberculosis In Patients With HIV Infection
Keywords:
pulmonary tuberculosis, HIV infection, Clinical profile of TB/HIV patients,CD4 countAbstract
Background: Tuberculosis is the commonest opportunistic infection and commonest cause of death in HIV/AIDS patients in India. Objective: To study the clinical, radiological and immunological profile of pulmonary tuberculosis in HIV infected patients. Methods: We conducted a retrospective study of 60 patients of pulmonary tuberculosis in patients with Human immunodeficiency virus positive. The diagnosis of tuberculosis was based on clinical evaluation, bacteriological examination including sputum smear and culture, tuberculin skin test and chest radiograph. CD4+ T cell counts were done on all patients. Results: Commonest risk factor for HIV transmission was sexual exposure in 47 cases (78%).35 cases (58.33%) had CD4+ T cell count <200/mm3, 25 cases (41.67%) had CD4+ T cell >200. constitutional symptoms (91.66%)like weight loss, anorexia, fatigue, night sweats are more common than classical symptoms of pulmonary TB like chest pain (66.66%) ,cough with/without expectoration (58.33%), dyspnoea (61.66%), fever (75%) and haemoptysis (8.33%). Most common opportunistic infection was oral/esophageal candidiasis (22%).35% of pstients had typical pattern and 65% had atypical pattern of pulmonary TB on chest radiograph. 80% of patients with CD4+ T cell count <200/mm3 had atypical pattern. In pulmonary tuberculosis sputum smear for AFB was positive in 20% cases & negative in 80% cases. Majority of the patients with positive sputum smear had CD4+T cell count >200/mm3. MDR-TB was documented in 9 (12%) of patients. 4 cases have CD4+ count <200and 5 cases have CD4+count >200. total mortality was 10% among 60 patients. Conclusion: Tuberculosis infection in patients with HIV is more common in second & third decade of life more common in males. Atypical features are more common than typical features in HIV-TB patients. Negative/anergic TST is more common in patients of HIV-TB co infection due to compromised CMI. Disseminated and multifocal lesions were more common in severe degree of immune compromise (CD4+ <200), whereas cavitory lesion and unifocal opacities were relatively more common in patients having CD4+ >200. Sputum AFB negative pulmonary TB is more if CD4 <200
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