THE OCCURRENCE OF CLINICALLY ACTIVE TUBERCULOSIS AMONG HIV-INFECTED PERSONS IN MUMBAI, INDIA. Öffentlichkeit
Hira, Rajiv Subhash (2014)
Abstract
Objective: To determine the CD4 count and HIV-1 viral load in HIV-infected persons in Mumbai, India developing incident Mycobacterium tuberculosis (MTB).
Patients &Methods: The database was from a prospective case-control study conducted at the teaching hospital of the MGM University, Mumbai during pre-ART era (2003-2004). It comprised of a purposive sample of 113 HIV-positive and 32 HIV-negative individuals with incident diagnosis of MTB; all adult, non-pregnant patients naïve to anti-tuberculosis treatment and ART. Investigations among other tests included Polymerase Chain Reaction test for MTB (TBPCR), Lowenstein Johnson (LJ) culture, CD4/CD8, and HIV-1 viral load count. Both bi-variate and multivariate analyses were performed using EpiInfo setting statistical significance at p<0.05 (2-tailed).
Results: The mean age of the cohort was 33.5+ 9.9 years. The ratio of male: female was 4:1. Among HIV-positive patients, the median CD4 counts were 340 cells/ml and viral load was log 0.6/ml. By comparison, for HIV-negative patients, the median CD4 counts were 758.5 cells/ml and viral load was log 0/ml. Between HIV+TBPCR+ (n=57) and HIV+TBPCR- (n=56) categories, the median CD4 count of 321 vs 480 cells/ml (p=0.03), median CD8 count of 480 vs 686 cells/ml (p=0.05), and HIV-1 viral load of log 1.1 vs 0.30 (p<0.001) were higher in HIV+TBPCR+ category. However, between HIV-TBPCR+ and HIV-TBPCR- categories, variables including the median CD4 count of 750 vs 770 cells/ml (p=0.25) and the median CD8 count of 633 vs 690 cells/ml (p=0.28) were not statistically different.
The performance of both MTB confirmatory tests, TBPCR and LJ culture (‘gold standard'), was not statistically different between all four groups. Regression analysis revealed a strong correlation between HIV infection status and TBPCR result even after adjusting for CD4 (F=44.97; p=0.02), adjusting for viral load (F=18.18; p=0.05), and when adjusting for both CD4 and viral load (F=31.02; p=0.009).
Conclusions: Incident MTB occurred in HIV-positive patients in Mumbai at median CD4 count of 321 cells/ml and viral load of log 1.1 particles/ml. With new WHO guidelines of 2013 recommending initiation of ART in HIV-positive patients at CD4 count <500 cells/ml, it may also help reduce occurrence of incident cases of MTB substantially.
Table of Contents
TABLE OF CONTENTS
Chapter
Title
Page #
I
Background/Literature Review
1-11
Hypothesis
1
Primary Study Objective
1
Background
2
Literature Search
3-7
References
8-11
II
Manuscript
12-39
A
Title/Abstract
12-13
B
Introduction
14
C
Patients & Methods
· Exclusion from IRB Review
· Study Population
· Laboratory Methods
· Primary Study Objective
· Analysis Plan
· Ethical Considerations
15-18
D
Results
18-20
E
Discussion
· Strengths and Limitations of the Study
20-25
F
References
26-29
G
Tables 1-7
30-37
H
Figures 1-2
38-39
III
Summary, Public Health Implications, Possible Future Directions
40-41
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