COVID 19 INFECTION IN A PATIENT NEWLY DIAGNOSED WITH HIV/TB COINFECTION – A CASE REPORT

HIV/TB coinfection, COVID 19 with HIV/TB, immune reconstitution inflammatory syndrome (IRIS), TB lymphadenopathy

Perceptions of nurses on TB with HIV adherence counselling skills in a health sub-district, Cape Town: A qualitative study

Background: People living with HIV (PLHIV) co-infected with Tuberculosis (TB) account for one in three HIV-related deaths. Retention in care and adherence to medication remain key behaviours that PLHIV co-infected with TB must adopt to achieve better health outcomes. Nevertheless, TB with HIV adherence-counselling services provided by nurses designed to enhance these behaviours remain inadequate. Additionally, limited information is found in the literature on the perceptions of nurses regarding their TB with HIV adherence counselling skills pertaining to PLHIV co-infected with TB. Aim: To explore and describe the perceptions of nurses regarding their TB with HIV adherence counselling skills of PLHIV co-infected with TB. Setting: The study was conducted in a health sub-district of Cape Town. Method: An exploratory, descriptive qualitative design was followed. A total of 14 purposively sampled nurses were interviewed individually. Nurses caring for PLHIV co-infected with TB were included and nurses not offering care to PLHIV co-infected with TB were excluded. All interviews were audio recorded with the participants' permission followed by verbatim transcriptions. Thematic analysis was done using ATLASti.8 electronic software. Results: It was established that the varied roles of these nurses increased their workload. Nonetheless, despite the gap in their counselling skills, the majority still maintained work expertise, professionalism and empathy towards the patients. Additionally, there were perceived barriers impacting patients' attendance of their follow up appointments. Conclusion: Based on the findings of this study, there is a need to equip nurses caring for PLHIV co-infected with TB with adherence counselling skills to improve practice.

Aspectos clínicos y epidemiológicos de los pacientes con tuberculosis extrapulmonar en la provincia de Santiago de Cuba / Clinical and epidemiological aspects of patients with extrapulmonary tuberculosis in Santiago de Cuba

Introducción: La tuberculosis es una infección bacteriana contagiosa, causada por el Mycobacterium tuberculosis, que afecta principalmente a los pulmones, pero puede propagarse a otros órganos. Objetivo: Describir las características clínicas y epidemiológicas de los pacientes con tuberculosis extrapulmonar en la provincia de Santiago de Cuba. Métodos: Se realizó un estudio descriptivo y retrospectivo de los 124 pacientes con tuberculosis extrapulmonar pertenecientes a la provincia de Santiago de Cuba, desde enero de 2007 hasta diciembre de 2017, registrados a través de la tarjeta de notificación de enfermedades de declaración obligatoria. La información se procesó de forma computarizada, a través del paquete estadístico SPSS, versión 20.0. Se utilizaron las frecuencias absolutas y relativas. Resultados: En la serie predominaron el sexo masculino (75,8 %) y el grupo etario de 30-44 años (35,5 %); asimismo, la forma clínica de presentación más frecuente resultó ser la pleural y el municipio con más afectados fue Santiago de Cuba, pero el mayor riesgo de enfermar por tuberculosis extrapulmonar lo presentaron los habitantes del municipio de Mella. Por otra parte, el factor de riesgo que más incidió fue el hábito tabáquico. Conclusiones: Las características clínicas y epidemiológicas encontradas no difieren del contexto epidemiológico mundial. Se observó un desplazamiento hacia edades más tempranas y el VIH no se consideró un factor determinante en la aparición de la enfermedad; igualmente, la sospecha clínica y epidemiológica de esta afección continúa siendo un pilar importante para el diagnóstico de las formas extrapulmonares, especialmente en la población de riesgo.

Introduction: Tuberculosis is a contagious bacterial infection, caused by the Mycobacterium tuberculosis that affects mainly the lungs, but it can spread to other organs. Objective: To describe the clinical and epidemiological characteristics of the patients with extrapulmonary tuberculosis in Santiago de Cuba. Methods: A descriptive and retrospective study of 124 patients with extrapulmonary tuberculosis belonging to Santiago de Cuba, was carried out from January, 2007 to December, 2017, registered through the notification card of diseases of obligatory declaration. The information was processed by computer, through the statistical package SPSS, version 20.0. The absolute and relative frequencies were used. Results: In the series the male sex (75.8%) and the 30-44 years age group (35.5%) prevailed; also, the most frequent clinical form of presentation was the pleural form and the municipality with more patients affected was Santiago de Cuba, but the higher risk of becoming sick due to extrapulmonary tuberculosis was in the municipality of Mella. On the other hand, nicotine addiction was the risk factor of more incidence. Conclusions: The clinical and epidemiological characteristics found don not differ from the world epidemiological context. A displacement toward earlier ages was observed and HIV was not considered a determining factor in the emergence of the disease; likewise, the clinical and epidemiological suspicion of this disorder continues being an important pillar for the diagnosis of extrapulmonary forms, especially in the risk population.

Occurrence of Rifampicin Resistant and HIV Co-Infection Tuberculosis in Ikere-Ekiti, Nigeria

@# Tuberculosis is a major cause of disability and death worldwide. One of the targets of Sustainable Goal Development for 2030 is to put an end to tuberculosis epidemics. This study accessed the occurrence of tuberculosis, its co-infection with HIV and rifampicin resistance in the study area, as well as the reliability of acid fast bacilli (AFB) test in tuberculosis (TB) diagnosis. Methods: The study, which was made up of both retrospective and prospective TB investigations, was carried out at the State Specialist Hospital, Ikere–Ekiti, Nigeria, covering April 2014 to March 2017. Sputum samples from 1227 individuals with suspected cases of TB, made up of 496 (40.42%) males and 731 (58.11%) females, were analysed for TB by smear microscopy for AFB and molecular determination using GeneXpert machine. Results: A total of 141 (11.49%) individuals were diagnosed tuberculosis positive using the GeneXpert machine, while 78 (6.36%) tested positive by AFB technique. Eleven (7.8 %) of the 141 tuberculosis-positive cases were rifampicin resistant; also a tuberculosis - HIV co-infection rate of 25.53% was obtained. The risk factors associated with TB in the study were smoking, alcoholism, over-crowding and HIV co-infection. Using the GeneXpert as a standard, the AFB’s sensitivity, specificity, positive predictive value (PPV) and negative predictive value were 43.26, 98.43, 78.20 and 93.04% respectively. Conclusion: The high occurrence of rifampicin resistant tuberculosis and HIV-TB co-infection are of serious concern. The low sensitivity and PPV values, as well as its inability to detect drug resistant TB, undermine the reliability of AFB.

Tuberculosis in North-East India: patient profile and treatment outcome of patient attending RNTCP

Background: Tuberculosis is a disease of global concern. India with its high burden of Tuberculosis, HIV and HIV-TB co-infection, this disease continue to have tremendous impact on its denizens especially the north-eastern states of the country because of its problem of HIV. It is imperative to understand every aspects of the disease for effective prevention and control.Methods: A retrospective record study of tuberculosis units was conducted.Results: The proportion of males was more as compared to females, with more cases seen with increasing age. Pulmonary TB was seen more among males, whereas extra-pulmonary TB was seen more among females. Favorable treatment outcome was seen in 84.7% of the population. HIV-TB Co-infection was seen 6.5% of the patients, with 46.3% having extra-pulmonary TB. Favorable treatment outcome was seen among them too.Conclusions: More common in males, showing increasing number of patients in older age group with favourable outcomes on treatment in all categories including HIV-TB co-infection patients.

Incidence of HIV infection in eastern Uttar Pradesh: HIV counseling and testing services record based retrospective study

Background: India has approximately 2.4 million of people living with HIV and out of these two thirds live in rural areas. This study may yield significant data to understand epidemiology of HIV/AIDS in this region that would help in designing techniques for effective implementation to prevent this infection.Methods: The present study was a comprehensive retrospective hospital-based investigation of the HIV infection in eastern Uttar Pradesh, India based on a large number of clinical samples at HCTS centre, representing different geographic regions and has been functional since 2002, conducting HIV tests, counselling of patients as well as maintains proper records.Results: A total of 444 HIV positive clients were registered in this retrospective study. The male and female ratio among all positive clients was 1.67:1 and the most common age group for both the genders was 35-49 years. Among 444 HIV positive clients, HIV-TB co-infection found in 72 (16.21%) cases. Out of 444 clients, 177 (40%) and 167 (38%) found extremely immunocompromised with low CD4 cells count in range between of 0-100 cells/mm3 and >100-350 cells/mm3 respectively. Mortality was seen in 72 (16%) out of 444 HIV positive clients.Conclusions: There is an urgent need of information, education about this disease and by providing suitable occupation or to make them aware, which will markedly help in preventing the spread of HIV pandemic in this geographical region.

Assessment of adherence to ATT among HIV-TB co-infected patients attending the ART centre of a tertiary care hospital of Jharkhand

Background: Despite being preventable and curable, TB is the leading cause of HIV associated mortality. It is the most common opportunistic infection among HIV positive individuals with CD4 cell count <500/ mm3. Worldwide the number of people infected with both HIV & TB is rising. The objective of the study was to describe the socio-demographic profile of HIV-TB co-infected patients and to assess the adherence of HIV TB Co-infected patients to anti tubercular treatment (ATT) attending ART Centre, RIMS, Ranchi.Methods: It was a hospital based prospective study done at Rajendra Institute of Medical Sciences (RIMS), Ranchi. Duration of study was 14 months. A total of 117 patients were registered during the study period and were followed up for adherence to ATT.Results: Out of 117 patients 4 were excluded. Among 113 patients, mostly were male (74.3%) and from rural background (69.9%). Majority (94.7%) of the patients came for regular follow up and took medicines as advised. Adherence was significantly associated with education (p=0.025).Conclusions: In this study it was concluded that education significantly affected adherence to ATT among HIV-TB Co-infected patients of ART Centre of RIMS, Ranchi.

Impact of CD4 count in the development of mycobacterium tuberculosis in patients with HIV infection in a tertiary care centre

Background: Patients with Human Immunodeficiency Virus (HIV) infection are predisposed to numerous opportunistic infections due to decreased cell mediated immunity, Tuberculosis being most common. Low CD4 count is associated with low immunity and higher risk of tuberculosis.Methods: Author conducted a retrospective study in the department of Pulmonary medicine in a tertiary care teaching hospital during January to December 2017. Author collected data of all the patients with HIV diagnosed with Tuberculosis from the ART centre. Author collected demographic details including age, sex, symptoms at presentation, details of diagnosis of TB including type of tuberculosis, CBNAAT results, CD4 count at the diagnosis of TB, details of ART therapy and ATT therapy and outcomes of treatment.Results: Eighty one patients with HIV-TB co- infection were included in the study. Males (70.37%) were more affected than females. Mean age of the study group was 39.97� years. Sixty one patients (75.4%) were diagnosed with Pulmonary Tuberculosis and 20 (24.6%) patients were diagnosed with extra pulmonary TB. Mean CD4 counts of the cohort was 226�0/祃. Eighty percent of patients developed Tuberculosis with CD4 count <250/祃.Conclusions: Author found in this study higher proportions of tuberculosis (80.2%) in patients with HIV infection with CD4 count <200/祃. Author also found higher proportion of pulmonary Koch抯 in patients with low CD4 count (CD4 <200/祃).

Expression and role of SOCS-3 and associated cytokines in HIV/TB coinfection / 中华实验和临床病毒学杂志

Objective@#To investigate the expression levels and clinical significance of serum suppressor of cytokine signaling-3 (SOCS3) and associated cytokines in HIV/TB co-infected patients.@*Methods@#The serum levels of SOCS3, IFN-γ, IL-2, IL-4, IL-6, IL-10, IL-17 and IL-22 were quantified by using enzyme-linked immunosorbent assays (ELISA) in 50 HIV-infected patients, 48 HIV/TB co-infected patients and 50 healthy donors. Pearson correlation analysis was used to analyze the correlation between SOCS3 and other seven cytokines.@*Results@#Serum levels of SOCS3 expression in HIV/TB co-infection group were significantly higher than those in HIV-infection alone and the control group. There was also significant correlation between SOCS3 and IFN-γ, IL-4, IL-6, IL-10, IL-2 in HIV/TB co-infection group.@*Conclusions@#These findings indicated that SOCS3 may play an important role in the immune response of patients with HIV/TB co-infection and it may be helpful in the diagnosis of HIV/TB co-infection.

Diagnostic Efficacy Of Gene X-Pert/ MTB-RIF Assay And Its Implication For The Treatment Of MDR TB In Rural Medical College.

Aims and objectives: To diagnose and treat the MDR Tuberculosis by XPERT MTB/RIF assay as early as possible so that transmission of infection can be minimized and To find out prevalence of MDR TB in our rural district of Maharashtra. Methods: This is a observational ,prospective study conducted over a period of 14 months ( Jan 15 to April 16 ) in the Dept. of Pulmonary Medicine, Shri Vasantrao Naik Gov.t Medical College, Yavatmal, Maharashtra. We have subjected 613 patients who fulfill the clinical criteria for RNTCP - MDRTB suspect 1.Treatment failure. 2. Retreatment case sputum positive at the end of 4 months, 3.Contact of known MDRTB case, 4.Sputum positive at diagnosis, retreatment case, 5. Any follow up sputum positive, 6.Other category (sputum negative retreatment cases), and 7. HIV-TB Cases. We have excluded all new cases (sputum positive, sputum negative and extrapulmonary cases ). With all precautions two sputum samples collected in the designated microscopy centre. One sample was subjected for routine ZN staining and other one for GENE X-PERT MTB/RIF assay. Result. Out of 613 MDR suspect subjects, 314 (51.23%) were found in the age group 30 to 50 which is economically productive age group. There were 428 (69.82%) male and 185 (30.18%) female. Out of total study patient 44 (7.18 %) were detected Rifampicin resistance by X-PERT MTB/RIF assay. Amongst MDR suspect criteria highest no (4.07 %) of Rifampicin resistant were found in Retreatment cases ( group 4 ) followed by 1.47 % in any follow up sputum positive ( group 5 ) , 0.65 % in sputum negative retreatment cases ( group 6), 0.32 % in treatment failure ( group 1 ) , 0.49 % in HIV TB cases (group7 and0.16 % in contacts of known MDR ( group 3) .There were 144 ( 23 .5 ) were co infected with HIV.TB. Conclusion: We conclude that GENE XPERT MTB /RIF assay has significant role in detecting Rifampicin resistance, patient can be started on treatment at the earliest thereby reducing morbidity, progression to XDR, mortality and transmission of MDR/XDR TB in the community can be minimized. However it has some shortcomings that it cannot detect resistance of other anti- tubercular drugs and atypical mycobacteria.[B.B.Bhadke NJIRM 2016; 7(5):33-39]

HIV testing, antiretroviral therapy, and treatment outcomes in new cases of tuberculosis in Brazil, 2011 / Pruebas de detección del VIH, tratamiento antirretrovírico y resultados del tratamiento en casos nuevos de tuberculosis en Brasil en 2011

ABSTRACT Objective To assess the implementation of HIV-related interventions for patients with tuberculosis (TB), as well as TB treatment outcomes in patients coinfected with HIV in Brazil in 2011. Methods This was a cross-sectional, operational research study of HIV-related interventions among TB cases and the sociodemographic and clinical characteristics of TB-HIV coinfected patients. It also used a retrospective cohort design to determine the association between antiretroviral therapy (ART) and favorable TB treatment outcomes. The source of data was a linkage of 2011 administrative health databases used by the National TB and HIV/AIDS Programs. Results Of 73 741 new cases of TB reported, 63.6% (46 865 patients) were tested for HIV; 10.3% were positive. Of patients with HIV, 45.9% or 3 502 were on ART. TB favorable outcome was achieved in 63.1% or 2 205 coinfected patients on ART and in only 35.4% or 1 459 of those not on ART. On multivariate analysis, the relative risk for the association between ART and TB treatment success was 1.72 (95% Confidence Interval = 1.64–1.81). Conclusions The linkage between national TB and HIV datasets has created a convenient baseline for ongoing monitoring of HIV testing, ART use, and TB treatment outcomes among coinfected patients. The low rates of HIV screening and ART use in 2011 need to be improved. The association between ART and treatment success adds to the evidence supporting timely initiation of ART for all patients with TB-HIV coinfection.

RESUMEN Objetivo Evaluar la ejecución de las intervenciones relacionadas con el virus de la inmunodeficiencia humana (VIH) en los pacientes con diagnóstico de tuberculosis y examinar los desenlaces del tratamiento antituberculoso en los pacientes coinfectados por el VIH en Brasil en 2011. Métodos Estudio de investigación operativa. Mediante un diseño transversal se evaluaron las intervenciones relacionadas con el VIH en los casos de tuberculosis y se describieron las características sociodemográficas y clínicas de los pacientes coinfectados por el VIH y la tuberculosis; con un diseño retrospectivo de cohortes se determinó la asociación entre el tratamiento antirretrovírico y los desenlaces favorables del tratamiento antituberculoso. Los datos se obtuvieron mediante un enlace administrativo de las bases de datos de salud del 2011 que utilizaron el Programa Nacional contra la Tuberculosis y el Programa contra el VIH/sida. Resultados De los 73 741 casos nuevos de tuberculosis notificados, se practicó detección del VIH en 63,6% (46 865 pacientes) y los resultados fueron positivos en 10,3%. De los pacientes coinfectados por el VIH, 45,9% o 3 502 pacientes, recibían tratamiento antirretrovírico. Se alcanzó un desenlace favorable de la tuberculosis en 63,1% (2 205) de los pacientes coinfectados que recibían tratamiento antirretrovírico, y en solo 35,4% (1 459) de los pacientes coinfectados que no recibían este tratamiento. Según el análisis multivariante, el riesgo relativo de asociación entre el tratamiento antirretrovírico y el éxito del tratamiento antituberculoso fue 1,72 (intervalo de confianza de 95%: de 1,64 a 1,81). Conclusiones El enlace de los registros nacionales sobre la tuberculosis y la infección por el VIH creó una referencia de base útil para el seguimiento continuo de la utilización de las pruebas de detección del VIH, la administración del tratamiento antirretrovírico y los desenlaces del tratamiento antituberculoso en los pacientes coinfectados. Es necesario mejorar las bajas tasas de detección sistemática del VIH y de administración del tratamiento antirretrovírico que se observaron en el 2011. Esta correlación entre el tratamiento antirretrovírico y el éxito del tratamiento antituberculoso avala la evidencia que respalda la iniciación oportuna del tratamiento antirretrovírico en todos los pacientes que presentan coinfección por el VIH y la tuberculosis.

Efficacy of Fluorescence Microscopy in the Diagnosis of Tuberculosis in Guyana.

Background: Tuberculosis is one of the potentially serious human diseases and is still one of the major causes of mortality. It ranks as the second most leading cause of death from a single infectious agent, after the human immunodeficiency virus (HIV). Objective: The aim of the study was to evaluate the efficacy of Fluorescence microscopy (FM) technique to determine sensitivity in detecting TB between HIV positive and HIV negative patients in a poor resource country. Methods: The study was a cross sectional and blind assessment on 50 suspected cases of TB among HIV positive and HIV negative patients using FM method against Zeihl Neelsen (ZN) staining method. Culture results were considered as gold standard. Results: Of the total 50 specimens examined by ZN, FM and culture method 32%, 40% and 38% were found positive by ZN, FM and culture respectively. FM was sensitive to ZN on several aspects. The difference in their case detection rates were statistically significant (2 = 35.3, p<0.001). In detecting overall patients for TB, FM method showed sensitivity of 90.0% (95% CI 68.3-98.5) over ZN method 75.0% (95% CI 50.9-91.3) with a kappa value of 0.83 (p≤0.05). FM method showed excellent sensitivity, sensitivity, PPV and NPV all with 100% (95% CI 48.0-100) among HIV-TB patients and an excellent kappa value of 1 (p≤0.05) Conclusion: This study presented greater sensitivity of FM method over conventional ZN staining method in detecting TB among HIV positive patients. Fluorescence microscopy can be widely used even in peripheral laboratories where culture facilities are not available.

CD4 count evaluation in HIV-TB co infection before and after anti-tubercular treatment.

Background: The global impact of Tuberculosis (TB) and Human Immunodeficiency Virus (HIV) co-infection is one of the major public health challenge. India has a very high burden of TB according to the WHO. A decrease in CD4 counts in HIV-TB co-infection leads to an increase in morbidity and mortality. Methods: Information regarding the duration of HIV, type of TB, CD4 counts before and after ATT and any associated Opportunistic Infections (OIs) were collected from the records of 100 patients with HIV-TB co-infection who attended ART centre for a period of one year. The collected data was statistically analyzed. Results: In the study group, 35 had Pulmonary Tuberculosis (PTB) and 65 had Extra Pulmonary Tuberculosis (EPTB), 40 had OIs. Mean CD4 count prior to ATT in PTB was 197 (7-940), EPTB 192 (13-683) and with OIs 129 (7-288). After completion in PTB was 300, EPTB 302 and 252 in OIs. Least CD4 count of 121 was observed in patients above 50yrs and after completion it was 133. Incidence of both EPTB and PTB was higher in males 66.2% and 62.9%, and in the age group of 31-50 yrs 50.8% and 60% (Cell counts expressed in cells/μl.). Conclusion: In our study, we found that there was significant recovery of CD4 cells following ATT. Difference in CD4 counts among patients with PTB and EPTB was not significant. There was remarkable reduction of CD4 counts in patients who had other OIs and the recovery after ATT was also marginal.

Características clínicas e epidemiológicas de pacientes com tuberculose na cidade com a maior incidência da doença no Brasil / Clinical and epidemiological characteristics of patients with tuberculosis in the city with the highest incidence of the disease in Brazil

INTRODUÇÃO: O controle da tuberculose é um grave problema de saúde pública. Em 2012, o Brasil contabilizou 71.230 novos casos com incidência de 45,4 casos/100 mil habitantes no Rio Grande do Sul e Alvorada é o município de maior incidência da doença no país. OBJETIVO: Assim, o objetivo deste estudo foi descrever o perfil dos pacientes com tuberculose no município de Alvorada e os fatores associados com o abandono do tratamento. MÉTODOS: Estudo transversal retrospectivo que avaliou todos os prontuários dos pacientes diagnosticados com tuberculose no município de Alvorada no período de 2008 a 2010. A associação entre as variáveis foi determinada com auxílio do SPSS 13.0. RESULTADOS: Foram avaliados 301 prontuários no período do estudo. A média de idade dos pacientes foi de 37,7 ± 14,8 anos, sendo 73% do sexo masculino. Declararam-se tabagistas 50,6% dos pacientes, 41,6% faziam uso de bebida alcoólica e 20,6% uso de drogas ilícitas. A forma clínica predominante foi a pulmonar e 17,0% dos pacientes apresentaram sorologia positiva para HIV. A cura ocorreu em 75,9% dos casos e 16,6% dos pacientes abandonaram o tratamento. A drogadição, o uso de cigarro, a idade e a positividade para o HIV foram variáveis associadas ao abandono do tratamento. CONCLUSÃO: Os resultados sugerem que pacientes mais jovens que fazem uso de drogas ilícitas, de cigarro e que são positivos para o HIV abandonam mais o tratamento. Deste modo, são necessárias medidas específicas que atinjam essa população para aumentar a taxa de cura e reduzir a taxa de abandono.

BACKGROUND: Tuberculosis control is a serious public health issue. In 2012, Brazil accounted for 71,230 new cases. In the state of Rio Grande do Sul the incidence was 45.4 cases per 100.000 inhabitants, and Alvorada is the city with the highest incidence in the country. AIM: This study aimed to describe the profile of patients with tuberculosis in Alvorada and the factors associated with treatment dropout. METHODS: This retrospective cross-sectional study evaluated medical records of all patients diagnosed with tuberculosis in Alvorada from 2008 to 2010. The association among variables was analyzed with SPSS 13.0.RESULTS: The mean age of patients was 37.7 ± 14.8 years, and 73% were male. 50.6% of patients were smokers, 41.6% were alcohol users, and 20.6% took illicit drugs. The predominant clinical presentation was pulmonary, and 17.0% of the patients tested positive for HIV. Cure was achieved in 75.9% of cases, and 16.6% of patients dropped out of treatment. Drugs and tobacco use, age, and HIV were variables associated with treatment dropout. CONCLUSION: The results suggest that younger patients who use illicit drugs and tobacco and who are positive for HIV present a higher dropout rate. Thus, specific measures are necessary in order to reach this population, increase the cure rate and reduce the dropout rate.

A rapid and low-cost microscopic observation drug susceptibility assay for detecting TB and MDR-TB among individuals infected by HIV in South India.

Background: The converging epidemics of HIV and tuberculosis (TB) pose one of the greatest public health challenges of our time. Rapid diagnosis of TB is essential in view of its infectious nature, high burden of cases, and emergence of drug resistance. Objective: The purpose of this present study was to evaluate the feasibility of implementing the microscopic observation drug susceptibility (MODS) assay, a novel assay for the diagnosis of TB and multi-drug-resistant tuberculosis (MDR-TB) directly from sputum specimens, in the Indian setting. Materials and Methods: This study involved a cross-sectional, blinded assessment of the MODS assay on 1036 suspected cases of pulmonary TB in HIV-positive and HIV-negative patients against the radiometric method, BD-BACTEC TB 460 system. Results: Overall, the sensitivity, specificity, positive predictive value, and negative predictive value of the MODS assay in detecting MTB among TB suspected patients were 89.1%, 99.1%, 94.2%, 95.8%, respectively. In addition, in the diagnosis of drug-resistant TB, the MODS assay was 84.2% sensitive for those specimens reporting MDR, 87% sensitivity for those specimens reporting INH mono-resistance, and 100% sensitive for specimens reporting RIF mono-resistance. The median time to detection of TB in the MODS assay versus BACTEC was 9 versus 21 days (P < 0.001). Conclusion: Costing 5 to 10 times lesser than the automated culture methods, the MODS assay has the potential clinical utility as a simple and rapid method. It could be effectively used as an alternative method for diagnosing TB and detection of MDR-TB in a timely and affordable way in resource-limited settings.

Pulmonary tuberculosis among HIV seropositives attending a counseling center in Kolkata.

The study was carried out to detect the prevalence of pulmonary tuberculosis among HIV-seropositive individuals (HIV/TB co-infection) who attended counseling center of National Institute of Cholera and Enteric Diseases, Kolkata. A total of 109 HIV-seropositive individuals were screened. Of them, 36 (33%) had HIV/TB co-infection diagnosed by chest X-ray and presence of acid fast bacillus (AFB) detected by repeated microscopic examination of sputum. Blood samples were examined for CD4 and CD8 counts and ratio. Findings of blood examination showed that low CD4 count (<50/μl) had statistically significant association (P = 0.007) with HIV/TB co-infection as compared to HIV infection only. However, no significant correlation with CD4:CD8 ratio in HIV/TB co-infection was observed.

Clinical response of newly diagnosed HIV seropositive & seronegative pulmonary tuberculosis patients with the RNTCP Short Course regimen in Pune, India.

Background & objectives In the Revised National Tuberculosis Control Programme (RNTCP) in India prior to 2005, TB patients were offered standard DOTS regimens without knowledge of HIV status. Consequently such patients did not receive anti-retroviral therapy (ART) and the influence of concomitant HIV infection on the outcome of anti-tuberculosis treatment remained undetermined. This study was conducted to determine the results of treatment of HIV seropositive pulmonary tuberculosis patients with the RNTCP (DOTS) regimens under the programme in comparison with HIV negative patients prior to the availability of free ART in India. Methods Between September 2000 and July 2006, 283 newly diagnosed pulmonary TB patients were enrolled in the study at the TB Outpatient Department at the Talera Hospital in the Pimpri Chinchwad Municipal Corporation area at Pune (Maharashtra): they included 121 HIV seropositive and 162 HIV seronegative patients. They were treated for tuberculosis as per the RNTCP in India. This study was predominantly conducted in the period before the free ART become available in Pune. Results At the end of 6 months of anti-TB treatment, 62 per cent of the HIV seropositive and 92 per cent of the HIV negative smear negative patients completed treatment and were asymptomatic; among smear positive patients, 70 per cent of the HIV-seropositive and 81 per cent of HIV seronegative pulmonary TB patients were cured. Considering the results in the smear positive and smear negative cases together, treatment success rates were substantially lower in HIV positive patients than in HIV negative patients, (66% vs 85%). Further, 29 per cent of HIV seropositive and 1 per cent of the HIV seronegative patients expired during treatment. During the entire period of 30 months, including 6 months of treatment and 24 months of follow up, 61 (51%) of 121 HIV positive patients died; correspondingly there were 6 (4%) deaths among HIV negative patients. Interpretation & conclusions The HIV seropositive TB patients responded poorly to the RNTCP regimens as evidenced by lower success rates with chemotherapy and high mortality rates during treatment and follow up. There is a need to streamline the identification and management of HIV associated TB patients in the programme with provision of ART to achieve high cure rates for TB, reducing mortality rates and ensuring a better quality of life.

Diagnosis of tuberculosis in an era of HIV pandemic: A review of current status and future prospects.

HIV and tuberculosis co-infection interact in fundamentally important ways. This interaction is evident patho-physiologically, clinically and epidemiologically. There are several differences between HIV-infected and HIV-uninfected patients with tuberculosis (TB) that have practical diagnostic implications. TB is more likely to be disseminated in nature and more difficult to diagnose by conventional diagnostic procedures as immunosuppression progresses. As TB rates continue to increase in HIV-endemic regions, improved diagnostic techniques merit consideration as TB-control strategies. There is a need to develop more user friendly techniques, which can be adapted for use in the high-burden and low-income countries. This review focuses on the diagnostic challenges in HIV-TB co-infection with an update on the current techniques and future prospects in an era of HIV pandemic.

CD4 cell count recovery in HIV/TB co-infected patients versus TB uninfected HIV patients.

Background: There is lack of data comparing the improvement in CD4 count following antitubercular (ATT) and antiretroviral therapy (ART) in patients presenting with Human Immunodeficiency Virus/Tuberculosis (HIV/TB) dual infection compared with CD4 matched cohort of TB uninfected HIV patients initiated on ART. We sought to test the hypothesis; TB additionally contributes to reduction in CD4 count in HIV/TB co-infected patients and this would result in greater improvement in count following treatment compared with CD4 matched TB uninfected individuals. Materials and Methods: In a retrospective cohort study design we studied the change in CD4 cell counts in two groups of patients - those with CD4 cell count >100 cells / mm 3 (Group 1) and <100/mm 3 (Group 2) at presentation. In each group the change in CD4 cell count in dually infected patients following six-month ATT and ART was compared to cohorts of CD4 matched TB uninfected patients initiated on ART. Results: In Group 1 (52 patients) dually infected subjects' CD4 count improved from 150 cells/ mm 3 to 345 cells/mm 3 (P=0.001). In the control TB uninfected patients, the change was from 159 cells/mm 3 to 317 cells/mm 3 (P=0.001). Additional improvement in dually infected patients compared to the control group was not statistically significant (P=0.24). In Group 2 (65 patients) dually infected subjects count improved from 49 cells/mm3 to 249 cells/mm 3 (P=0.001) where as in control TB uninfected patients improvement was from 50 cells/ mm 3 to 205 cells/mm 3 (P=0.001), there being statistically significant additional improvement in dually infected subjects (P=0.01). Conclusion: Greater increment in CD4 counts with ATT and ART in dually infected patients suggests that TB additionally influences the reduction of CD4 counts in HIV patients.

CCR2, MCP-1, SDF-1α & DC-sign gene polymorphisms in HIV-1 infected patients with & without tuberculosis.

Background & objectives: Variability in the clinical outcome of persons exposed to and infected with HIV-1 and tuberculosis (TB) is determined by multiple factors including host genetic variations. The aim of the present study was to find out whether chemokine, chemokine receptor and DC-SIGN gene polymorphisms were associated with susceptibility or resistance to HIV and HIV-TB in south India. Methods: CCR2 V64I (G/A), monocyte chemoattractant protein-1 (MCP-1) -2518 A/G, stromal cell derived factor-1α (SDF-1α) 3’UTR G/A and DC-SIGN gene polymorphisms were studied by polymerase chain reaction based methods in HIV-1 infected patients without TB (n=151), with pulmonary TB (PTB) (n=81) and extrapulmonary TB (n=31), 155 PTB patients without HIV and 206 healthy controls. Results: The genotype frequencies of CCR2 V64I, MCP-1 -2518 and DC-SIGN polymorphisms did not differ significantly between the study groups. A significantly increased frequency of GG genotype of SDF-1α polymorphism was observed among HIV+PTB+ patients compared to healthy controls (P=0.009, Pc=0.027). Interpretation & conclusions: Our data suggest that GG genotype of SDF-1α 3’UTR polymorphism may be associated with susceptibility to PTB in HIV-1 infected patients. A better understanding of genetic factors that are associated with TB could help target preventive strategies to those HIV patients likely to develop tuberculosis.