ABSTRACT
HIV infection reduces the immune system and is the most significant factor in the spread of TB in recent years and one of the causes of death in HIV-seropositive patients. TB is the most commonly diagnosed opportunistic infection and the most frequent direct cause of death among HIV infected patients. The HIV infection can accelerate progression of TB infection to active TB disease. Among patients with active TB, those with HIV coinfection have the greatest risk for relapse. Regardless of increasing rate of TB and HIV in Iran, we decided to survey outcome of TB in HIV positive patients who treated with standard regimens in the years 2003-2012. This retrospective cohort study was conducted on HIV-positive patients with TB referred to Behavioral Diseases Consultation Center and Infectious Diseases Ward of Imam Khomeini Hospital from 2003 to 2012. Outcome was defined as failure, relapse and mortality. Moreover, the relationship between outcomes and number of CD4, co-trimoxazole and antiretroviral intake, type of TB and AIDS defining illness was studied. This study had 135 patients, 8 [5.9%] were females and 127 [94.1%] were males. The mean age of the patients was 40.14+10.02 and the most way to catch HIV in this study was intravenous drug user. There were 3 [2.22%] cases of failure, 15 [11.1%] relapse, and 21 [15.8%] deaths. Antiretroviral therapy, AIDS defining illness, type of TB and co-trimoxazole intake did not soley affect relapse. CD4 level was the most effective variables in relapse [Hazard ratio: 0.392 [0.11-1.4]; Relative Risk: 0.809 [0.593-1.103] [P=0.068]]. However, regard to CI95%, the impact of CD4 on relapse is not significant and antiretroviral intake was the most important and effective variable in increasing their survival. Hazard ratio: 0.137 [0.141-0.45]; Relative Risk: 0.686 [0.513-0.918] [P=0.001]. Overall, receiving antiretroviral was the most important factor influencing the outcome of patients
ABSTRACT
It is estimated that one third of the world's population is latently infected with tuberculosis [TB]. The HIV epidemic fuels the TB epidemic by increasing the risk of reactivation of latent TB infection and by facilitating a more rapid progression of TB disease. Although the incidence of TB is constant or decreasing in many regions of the world, rates remain high in developing countries as a consequence of the HIV epidemic. This study was conducted as a collaboration of the Infectious Diseases department of Imam Khomeini Hospital with the Microbiology department of Tehran University of Medical Sciences. The hospital dataset of 94 patients admitted with TB during 2003-2005 was reviewed. We aimed to study factors correlating with positive blood culture including age, sex, immune deficiency status, HIV serology and SIRS [Systemic Inflammatory Response Syndrome] status. In this study, we found that positive blood cultures are more frequent in patients less than 45 years old. Positive blood cultures were also more frequent in HIV infected patients and there was a significant correlation between blood culture and SIRS status. Therefore, we recommend that we obtain blood cultures from these high-risk groups in order to increase early detection of TB