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Indian Journal of Community Medicine

A Study of Prevelance of HIV in Tuburculosis Cases

Author(s): BS Deswal, D. Bhatnagar*, D. Kumar**, VR Deshpande***

Vol. 27, No. 2 (2002-04 - 2002-06)

DADH, HQ 5 Mtn Div, C/o 99 APO *Officer Commanding, Station Health Org., Allahabad **Asst Professor, MLN Medical College, Allahabad ***ADH & Sr. Advisor, HQ 4 Corps, C/o 99 APO

Abstract:

Research question: What is the prevalence of HIV infection among adult TB cases.

Objectives: (i) To find out the prevalence of HIV infection among adult TB cases. (ii) To study some epidemiological and socio-demographic factors associated with TB-HIV co-infection.

Study design: Cross-sectional study over the period of three years.

Setting: Two large referral Chest and TB hospitals at Allahabad (U.P.).

Participants: TB patients in age group of 20 years and above.

Study variables: Age, sex, marital status, religion, social support (staying with family), alcohol consumption, sexual behaviour, history of blood transfusion and IV drug use.

Statistical analysis: Chi-square (*2) test.

Results: A total of 6707 adult TB cases were screened for HIV seropositivity of which 1.69% were found positive. Majority of the cases (99%) were in sexually active age group. HIV seropositivity was observed in both sexes and all religions with no significant difference. HIV prevalence was more in TB cases not staying with family and alcohol consumers. Heterosexual promiscuity was observed in 57% of cases and 36% were indeterminates. TB-HIV co-infection showed an increasing trend from years 1998 to 2000.

Keywords : Tuberculosis, HIV, Seropositivity

Introduction:

Tuberculosis is a major cause of morbidity and mortality in developing countries. To make the situation worse, tuberculosis has formed a lethal partnership with HIV. HIV is known to cause immunosuppression and accelerates the speed at which tuberculosis progresses from a dormant lesion to life threatening condition. The estimated 10% activation of dormant TB infection over the life span of an infected person is increased to 10% activation in one year if HIV infection is superimposed1,2. The present study was undertaken to find out the prevalence of HIV and tuberculosis co-infection and to study their distribution as per their socio-demographic profile among adult TB cases.

Material and Methods:

The study was undertaken among the adult TB cases in two referral Chest and TB disease hospitals at Allahabad (U.P.) between January 1998 to December 2000. All the TB patients in age group of 20 years and above were screened for HIV antibodies by using spot kit (Immunocomb, Bispot and capillus). Those who were found positive were rechecked and confirmed by ELISA on two different samples. Other tests conducted were sputum for AFB for three days by ZN stain, sputum culture for Mycobacterium tuberculosis by LJ media, montoux test and X-ray chest. The data was collected on a pretested proforma having details of age, sex, religion, marital status, sexual behaviour, blood transfusion history, alcohol consumption and IV drug use etc. Follow up of HIV positive cases was done to the extent possible. The data was statistically analysed by using chi square (*2) test.

Results:

Table I: Age and sex distribution of TB and HIV cases.

Age group Number of cases Percentage
Prevalence
TB HIV
Male Female Total Male Female Total
20-29 1820 1390 3210 26 19 45 1.40
30-39 1572 1130 2702 31 22 53 1.96
40-49 395 285 680 09 06 15 2.20
50 & above 66 49 115 01 - 01 0.87
Total 3853 2854 6707 67 47 114 1.69

*2 = 4.68, df = 4, p>0.05

Out of 6707 TB cases screened for HIV seropositivity, 114 cases were found positive thus overall prevalence was found to be 1.69%. Majority of the cases (99%) were in sexually active age group (20-49 years). Prevalence of HIV among male TB cases was 1.73% and among female TB cases was found to be 1.64%. The difference between two sexes was not significant (p>0.05). HIV seropositivity was found in all religions but the difference was not significant.

Table II: Marital status of TB and HIV cases.

Category No. of cases Percentage prevalence
TB HIV
Married 5810 98 1.68
Unmarried & others 897 16 1.78
Total 6707 114 1.69

*2 = 0.006, df = 1, p>0.05.

HIV seropositivity was observed in both married and other groups of TB cases with no significant difference.

Table III: Social support of TB and HIV cases.

Age group No. of cases Percentage
TB HIV prevalence
Staying with family   99 1.59
Staying without family 483 15 3.10
Total 6707 114 1.69

*2 = 6.71, df = 1, p<0.05

The TB cases staying separately from families had significantly higher prevalence of HIV.

Table IV: Alcohol consumption habit of TB and HIV cases.

Category No. of cases Percentage
TB HIV prevalence
Alcohol consumer 1520 50 3.28
Teetotaller 5187 64 1.23
Total 6707 114 1.69

*2 = 29.63, df = 1, p<0.001

The TB cases who had habit of alcohol consumption had significantly higher prevalence of HIV.

Table V: Risk behaviour analysis of TB and HIV cases.

Category No. of cases Percentage
TB HIV prevalence
Heterosexual promiscuous 112 64 57.14 33.33
Homosexual 06 02 33.33
History of blood transfusion 09 03 33.33
IV drug users 05 04 80.00
None of the above 6575 41 0.06
Total

6707

114 1.69

*2 = 21.22, df = 4, p<0.001

Out of 114 HIV positive cases, 73(64%) gave history of risk behaviour but 41 cases (36%) remained in determinates.

Table VI: Year-wise distribution of TB and HIV cases.

Category No. of cases Percentage
TB HIV prevalence
1998 2379 17 0.71
1999 2062 34 1.64
2000 2266 63 2.78
Total

6707

114 1.69

*2 = 29.5, df = 2, p<0.001

TB cases found HIV positive showed a significant (p<0.001) increasing trend with time from 1998 to 2000.

Discussion:

In the present study, out of 6707 adult TB cases, 1.69% had HIV infection. Kulshreshtha et al3 in their study conducted at Lucknow revealed 1.42% prevalence of HIV in TB patients and Shivaraman et al4 from South India reported 2.7% co-infection of HIV and TB. A study conducted among defence personnel by Kataria et al5 found 1.06% patients had co-infection of TB and HIV while Arora et al6 in their study in Haryana reported HIV infection to be 9.7 per thousand in TB patients in Haryana. Co-infection of HIV and TB in western countries is reported to be high - 59% in Cuba7, 51% in San Francisco8 and 63% in Los Angeles9. It was observed in the present study that most of the HIV cases (99%) were in sexually active age group (20-49 years) which is in conformity with other studies5,10. HIV positivity was seen in both sexes and all religions and there was no significant difference. In the present study, the individuals staying with family were found to be less prone to TB-HIV co-infection as compared to those staying without family which may be a factor facilitating the extra marital sexual exposure. The studies carried out by Kataria et al5 also reported similar observations. Drinking habit was found to be a contributing factor for visiting commercial sex workers and thus seems to be important risk factor.

Similar observations were made by other workers5.

The risk behaviour analysis revealed that hetero sexual promiscuity was present in 56% of cases but in 35% of cases no cause of transmission could be ascertained inspite of repeated enquiry of the individuals. About 50% of the spouses were also found positive in married cases. A study conducted by Kataria et al5 identified high risk behaviour in 46.7% cases and remaining 53.3% were indeterminates. A study from British Columbia11 identified high risk behaviour factor in 90% of the positive cases. Tuberculosis cases found HIV positive showed an increasing trend with time from 1998 (0.71%) to 2000 (2.78%) year. A similar marked increase in seropositivity has also been reported in other studies conducted by Shivraman et al4 and Soloman et al12. All the cases which were found HIV positive on screening by rapid test kits were confirmed by ELISA and none was negative, thus these kits were found equally sensitive and specific for detection of HIV seropositivity. This is in conformity with other studies5,6.

References:

  1. World Health Organisation, Fighting Diseases - Fostering Development, Report of Director General. World Health report, 1996.
  2. Park K. Text book of Preventive and Social Medicine, 15th Edition 1997, p-150.
  3. Kulshreshtha R, Nigam M, Sarin S, Mathur A. Prevalence of HIV in tuberculosis patients, Indian J Med Microbiol 1997; 15: 79-81.
  4. Shivaraman V, Fernandez G, Sambashiva S. Trends of HIV infection in pulmonary tuberculosis. Indian J Tuberculosis 1992; 39: 37-40.
  5. Kataria VK, Rosha D, Maudar KK. HIV and tuberculosis co-infection in referral chest hospital. Med J Armed Forces India 2000; 56: 298-300.
  6. Arora DR, Gupta V, Arora B. Surveillance of HIV infection in Haryana. Indian J Community Med 2000; 15: 19-21.
  7. 7.Diaz JM, Gonzalez NI, Saladrigas C, Perez AJ, Milan JC, Valdivia JA. Tuberculosis and HIV co-infection in Cuba. Rev Cabana Med Trop 1996; 48: 214-7.
  8. Chairson RK, Thewar CP. Tuberculosis in patients with AIDS. Am Rev Resp Dis 1987; 136: 570-4.
  9. Asch SM, London AS, Barnes PF, Goleberg L. Testing HIV infection among TB patients in Los Angeles. Am J Resp Crit Care Med 1997; 155: 378-81.
  10. Pal D, Chottapadhyay UK, Raut DK, Dass BN. HIV infection in commercial sex workers in Calcutta, A preliminary report. Ind J Med Microbiol 1999; 17: 32-3.
  11. Blenkush MF, Korzeniewska KM, Elwood RK, Black W, Fitzerald JM. Risk factors analysis of HIV/AIDS among Columbians. Clin Inves Med 1996; 19: 271-8.
  12. Soloman S, Anuradha S, Rajasekharan S. Trend of HIV infection in pulmonary tuberculosis in South India J Tubercle and Lung Dis 1995; 76: 17-9.
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