Factors Associated with Prevalent Tuberculosis Among Patients Receiving Highly Active Antiretroviral Therapy in a Nigerian Tertiary Hospital

Background: Tuberculosis (TB) causes significant morbidity/mortality among human immunodeficiency virus­infected individuals in Africa. Reducing TB burden in the era of highly active antiretroviral therapy (HAART) is a public health priority.Aim: We determined the factors associated with prevalent TB among patients receiving HAART.Subjects and Methods: We conducted a cross­sectional study of adult patients who had received HAART for ≥12 weeks in a Nigerian tertiary hospital. Patients whose TB diagnosis predated HAART were excluded from the study. Pre­HAART data were collected from the clinic records, whereas post­HAART data were obtained through medical history, physical examination, and laboratinvestigations.StandardTBscreening/diagnostic algorithms as applicable in Nigeria were used. Logistic regression analysis was used to determine factors independently associated with prevalent TB.Results: about 65.8% (222/339) were women. The mean age was 41.1 (10.0) years and 23.6% (73/339) had past history of TB. The prevalence of active TB was 7.7% (26/339). Among these patients, 42.3% (11/26) had pulmonary TB, 34.6% (9/26) had disseminated TB, whereas 23.1% (6/26) had only extra­pulmonary disease. Only 45% (9/20) of patients with pulmonary involvement had positive sputum smear. Factors independently associated with prevalent TB were lower social class (adjusted odds ratio [aOR]: 31.7; 95% confidence interval [CI]: 1.1­1417.3), HAART non­adherence (aOR125.5; 95% CI: 9.6­1636.3), baseline CD4 <200cells/µl (aOR31.0; 95%CI: 1.6­590.6), previous TB (aOR13.8; 95% CI: 2.0­94.1), and current hemoglobin <10 g/dl (aOR10.3; 95% CI: 1.1­99.2).Conclusion: Factors associated with prevalent TB were a lower social class, HAART non­adherence, severe immunosuppression before HAART initiation, previous TB, and anemia post­HAART. TB case finding should be intensified in these high­risk groups

Opportunistic infections and HIV clinical disease stage among patients presenting for care in Phnom Penh, Cambodia.

This prospective, cross-sectional study sought to assess the spectrum of HIV-associated complications and disease stage among individuals presenting for first-time care in Phnom Penh, Cambodia between November 2001 and September 2002. One hundred patients participated in this study. All study participants presented with advanced stages of HIV disease. Seventy-four percent of the subjects had CD4 cell counts <50 cells/mm3. Tuberculosis was the most common AIDS-defining illness among participants, with a prevalence of 43%. A spectrum of other opportunistic infections, including cryptosporidiosis (13%), severe bacterial infections (12%), cryptococcosis (12%), and Pneumocystis jiroveci pneumonia (10%), was identified. These findings underscore the need for widespread HIV treatment and prevention in this setting. Increased screening for HIV and routine health maintenance for those infected are urgently needed in order to facilitate management of both opportunistic infections and the secondary prevention of HIV infection.

The first reported cases of disseminated histoplasmosis in Cambodia, complicated by multiple opportunistic infections.

Although disseminated histoplasmosis is recognized as a common opportunistic infection in HIV-infected persons living in endemic areas, it is not widely reported in Southeast Asia, and has not been reported in Cambodia. It remains unanswered whether this is secondary to a low disease prevalence, or whether the disease, which is associated with a nonspecific clinical presentation, is under diagnosed. In addition to a review of the literature regarding histoplasmosis in Southeast Asia, we provide a description of two HIV-1 infected patients with documented disseminated histoplasmosis complicating other opportunistic infections in Phnom Penh, Cambodia. These two cases highlight the need for both a high clinical suspicion, and reliable laboratory testing, in a setting where there is likely to be more than one infection complicating the patient's clinical course.