Epidemiology of tuberculosis and human immunodeficiency virus co-infection, clinical presentations and impact on immunohaematological parameters in Mombasa county, Kenya.
Ayieko, Yonge Shadrack
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Tuberculosis still represents an important global public health threat and it is one of the world‘s leading causes of death and HIV/AID has substantially altered the epidemiology of the infection especially in Sub-Saharan Africa. Most of death due TB and TB-HIV co-infection could be averted if clinicians recognized the signs and symptoms of the two diseases and instituted appropriate measures without delay. The magnitude of TB and TB-HIV co-infection is increasing despite progress made in the ART/DOTs control programs. There is no adequate knowledge on TB-HIV coinfection and effect on immune system since immunohaematological cell counts are not routinely carried out on TB patients. This hospital and laboratory based descriptive cross-sectional study was carried in Mombasa County. The main objective was to determine the magnitude of TB and TB-HIV co-infection and their relationship with clinical markers. Sputum from five hundred tuberculosis suspects were examined for AFB and cultured on solid and liquid media. Drug susceptibility test was done using BACTEC MGIT 960 incubator. Blood samples from tuberculosis suspects were screened for human immunodeficiency virus. Complete blood cell count was done using Sysmex Kx-2 and CD4+T cells analysed using FACS count flow cytometer. A questionnaire was used to collect demographic and medical history of the tuberculosis suspects. The data was entered in MS Excel 8.0 and analysed using Epi-Info 6.04b and statistical package for social sciences (SPSS) version 16.0 software. Pearson‘s chi-square test of independence was used to determine level of associations between TB-HIV co-infection and clinical outcomes. Student t test was used to test differences of means between two or more groups and Odds ratio to assess risk factors related to outcomes. Results showed tuberculosis prevalence was 42.0% and it was significantly higher in females (45.9%) than males 38.7% (P<0.05). Two hundred and two patients (96.2%) had pulmonary tuberculosis and eight (3.8%) extra-pulmonary tuberculosis. Smear positivity rate was 81.1% and culture positives 100%. Tuberculosis recurrence rate was 14.3% and was significantly associated with HIV infection (p<0.05). The majority of the TB cases (38.6%) were aged between 25-34 years (OR=58; CI; 0.340.94; p<0.05). Tuberculosis-HIV co-infection rate was 37.1% and it was not significantly associated with gender (P>0.05). Clinical features of chronic dry cough, fever, night sweats and weight loss were common in both TB and TB-HIV co-infected patients. Tuberculosis patients had higher CD4+T cell counts (474.5±198.8 cells/mm3) than co-infected patients (276.44±142.71) (t=5.6,df=461,p<0.05) but lower than reference group (1054.9 ± 156.1 cells/mm3, t=34.6, df=485, p<0.05). HIV/AIDS patients had significantly higher body mass index (19.9±2.2 kg/m2) than tuberculosis HIV/AIDS co-infected patients (BMI 18.8±2.7, t=0.70, df=58, p<0.05). The mean packed cell volume in TB-HIV co-infected patients was (32.31±4.8%) lower than TB patients without HIV/AIDS (34.21±4.4%) and the control group (36.41±4.2%). A high rate of drug resistance was observed in isoniazid (17.6%) and rifampicin (2.1%). Eight patients had multi-drug resistant-TB (4.8%). Any type of drug resistance in TBHIV co-infection patients was 19.1% suggesting a positive correlation (p<0.05). The high prevalence of tuberculosis and high co-infection in this study underscores the need for more efforts and resources to increase knowledge and access health care. There is also need to improve drug susceptibility testing to all newly diagnosed tuberculosis patients in all health facilities to monitor drug resistance. Immunohaematological indices (CD4 count, FBC and ESR) be performed routinely to monitor both TB and TB-HIV co-infection patients.