HIV-infected presumptive tuberculosis patients without tuberculosis: How many are eligible for antiretroviral therapy in Karnataka, India?

ABSTRACT

For certain subgroups within people living with the human immunodeficiency virus [HIV] [active tuberculosis [TB], pregnant women, children <5 years old, and serodiscordant couples], the World Health Organization recommends antiretroviral therapy [ART] irrespective of CD4 count. Another subgroup which has received increased attention is ''HIV-infected presumptive TB patients without TB". In this study, we assess the proportion of HIV-infected presumptive TB patients eligible for ART in Karnataka State [population 60 million], India. This was a crosssectional analysis of data of HIV-infected presumptive TB patients diagnosed in May 2015 abstracted from national TB and HIV program records. Of 42,585 presumptive TB patients, 28,964 [68%] were tested for HIV and 2262 [8%] were HIV positive. Of the latter, 377 [17%] had active TB. Of 1885 ''presumptive TB patients without active TB", 1100 [58%] were already receiving ART. Of the remaining 785 who were not receiving ART, 617 [79%] were assessed for ART eligibility and of those, 548 [89%] were eligible for ART. About 90% of ''HIV-infected presumptive TB patients without TB" were eligible for ART. This evidence supports a public health approach of starting all ''HIV-infected presumptive TB patients without TB" on ART irrespective of CD4 count in line with global thinking about 'test and treat'