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

ABSTRACT

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