Clinical manifestations and antiretroviral management of HIV/AIDS patients with tuberculosis co-infection in Kramat 128 Hospital.

ABSTRACT

AIM: to give a description of HIV-AIDS and tuberculosis co-infection in Jakarta, viewed from the perspective of virologic and immunologic status and the correct selection of antiretrovirals. METHODS: cross-sectional descriptive study was performed on the outpatient clinic of Kramat 128, from June to July 2007. Tuberculosis infection was confirmed chest X-ray or sputum acid fast smear. Viral load was determined by Polymerase Chain Reaction (PCR) and CD4 count done by flow cytometry. The data were then analyzed using SPSS 14th and Chi Square tests for proportional data. RESULTS: the study enrolled 130 patients with the prevalence of tuberculosis co-infection of 66.9% (n=87). The TB co-infected patients came with more clinical manifestations (3-4 manifestations) than the non co-infected ones (2-3 manifestations; p<0.001). They also underwent more hospitalizations (44.8% vs. 11.6%, p=0.003), had lower CD4 levels (126.49 cell/microL vs. 240.68 cell/microL; p=0.001) and more patients with CD4 levels of below 100 cell/microL (64.6% vs. 25.6%; p<0.001). The co-infected patients had more virologic failure than the non co-infected ones (38% vs. 12.5%; p=0.030), and so did the co-infected patients treated with nevirapine than those treated with efavirenz (37.8% vs. 6.3%; p=0.019). CONCLUSION: tuberculosis co-infection complicated the clinical management of People Living with HIV-AIDS (PLWHA) and the antiretroviral regimen selection in these patients need to be modified. Subsequent studies were needed to confirm this study result of superior efavirenz based therapy in the TB co-infected PLWHA.