print view Emory Login:
(Login to submit or manage theses and dissertations)

Contact Us

Instructions

Frequently Asked Questions

ETD Help

Policies and Procedures

Copyright and Patents

Access Restrictions

Search ETDs:
Advanced Search
Browse by:
Browse ProQuest
Search ProQuest

Laney Graduate School

Rollins School of Public Health

Candler School of Theology

Emory College

Emory Libraries

THE OCCURRENCE OF CLINICALLY ACTIVE TUBERCULOSIS AMONG HIV-INFECTED PERSONS IN MUMBAI, INDIA.

Hira, Rajiv Subhash (2014)
Master's Thesis (49 pages)
Committee Chair / Thesis Adviser: Sullivan, Patrick S
Committee Members:
Research Fields: Health Sciences, Public Health; Health Sciences, Epidemiology
Partnering Agencies: University, college or educational institution (other than Emory) ; Hospital or other health care provider
Keywords: HIV; Tuberculosis; PCR; Mumbai; India; Incident TB; TB
Program: Rollins School of Public Health, Epidemiology (Epidemiology)
Permanent url: http://pid.emory.edu/ark:/25593/g03xh

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

Files

application/pdf Master's Thesis 49 pages (532.1 KB) [Access copy of Master's Thesis]
Permission granted by the author to include this thesis or dissertation in this repository. All rights reserved by the author. Please contact the author for information regarding the reproduction and use of this thesis or dissertation.