Background: Tuberculosis (TB) is a specific infectious disease caused by mycobacterium tuberculosis while acquired immune deficiency syndrome (AIDS) is a fatal illness caused by human immunodeficiency virus (HIV). Both of them constitute the main burden of infectious public health disease in many parts of the world, particularly in resource limited countries like Nigeria. This study sets out to describe TB/HIV co-infected patients accessing care at the DOTS clinic in a tertiary hospital in South-Eastern Nigeria. Methods: This study was conducted retrospectively at the DOTS clinic of NAUTH Nnewi. A structured proforma was used to extract specific characteristics of TB/HIV co-infected patients who received TB treatment for the period of 1st January 2013 to 31st December 2013. The collected data were analyzed with SPSS version 20. Results: Ninety eight patients (40.6%) were TB/HIV co-infected, out of the two hundred and forty one patients treated for tuberculosis in the DOTS clinic during the period under review. These were the findings among the TB/HIV co-infected patients: there were more females (51%) than males (49%); the commonest age group affected was the group 30 - 39 years (34.7%); majority of the patients (91.8%) had pulmonary TB as against extrapulmonary TB (8.2%) and most of the patients had negative sputum AFB result (43.9%) as against those with positive result (36.7%). Conclusion: This study demonstrated some important characteristics of TB/HIV co-infected patients. Such knowledge if taken into consideration in both the tuberculosis control and HIV control programs will improve the outcomes of the programs.
Tuberculosis (TB) is a specific infectious disease caused by mycobacterium tuberculosis while acquired immune deficiency syndrome (AIDS) is a fatal illness caused by human immunodeficiency virus (HIV). Both of them constitute the main burden of infectious public health disease in many parts of the world, particularly in resource limited countries like Nigeria. Worldwide, the number of people infected with both HIV and TB is rising and to make the global situation worse, TB has formed a lethal partnership with HIV. The HIV virus damages the body’s natural defenses and the immune system and accelerates the speed at which tuberculosis progresses from a harmless infection to a life-threatening condition. People with HIV are at risk of being newly infected, if they are exposed to TB because their weakened immune system makes them more vulnerable. This results to premature death if left untreated. This unholy association between TB and HIV means that people suffer additional discrimination.
The estimated 10 percent activation of dormant TB infection over the life span of an infected person is increased to 10 percent activation in one year, if HIV infection is superimposed [
It is estimated that about 14 million individuals worldwide are TB/HIV co-infected [
This study was conducted retrospectively at the DOTS clinic of Nnamdi Azikiwe University Teaching Hospital (NAUTH) Nnewi. The hospital is a tertiary hospital. The source of data was the clinic register. A structured proforma was used to extract specific characteristics of TB/HIV co-infected patients who received TB treatment for the period of 1st January 2013 to 31st December 2013. Characteristics sought included age, sex, weight, place of residence, sputum AFB status, site of TB infection, treatment regimen, and category of patients.
The collected data were entered into international business machines-statistical package for social sciences (IBM-SPSS) version 20, and analysed. Results were presented in tables showing frequencies and percentages for easy appreciation. Chi square test was used to determine association between socio-demographic characteristics and some categorical variables including site of disease, sputum AFB status, antiretroviral status, treatment regimen etc. Ethical approval was sought for and obtained by the Nnamdi Azikiwe University Teaching Hospital Ethical Committee (NAUTHEC).
Ninety eight patients (40.6%) were TB/HIV co-infected, out of the two hundred and forty one patients treated for tuberculosis in the DOTS clinic during the period under review.
Variable | Frequency (%) N = 98 |
---|---|
Sex | |
Male | 48 (49.0) |
Female | 50 (51.0) |
Total | 98 (100.0) |
Age (in years) | |
<20 | 24 (24.5) |
20 - 29 | 10 (10.2) |
30 - 39 | 34 (34.7) |
40 - 49 | 22 (22.4) |
50 - 59 | 7 (7.1) |
60 - 69 | 1 (1.0) |
Total | 98 (100.0) |
Weight (kg) | |
<20 | 12 (12.2) |
20 - 29.99 | 7 (7.1) |
30 - 39.99 | 4 (4.1) |
40 - 49.99 | 22 (22.4) |
50 - 59.99 | 29 (29.6) |
60 - 69.99 | 16 (16.3) |
70 - 79.99 | 7 (7.1) |
Missing | 1 (1.0) |
Residence | |
Urban | 61 (62.2) |
Rural | 37 (37.8) |
Total | 98 (100.0) |
Variable | Frequency (%) N = 98 |
---|---|
Disease site | |
Pulmonary | 90 (91.8) |
Extrapulmonary | 8 (8.2) |
Total | 98 (100.0) |
AFB status | |
Positive | 36 (36.7) |
Negative | 43 (43.9) |
Unable to produce sputum | 15 (15.3) |
Others | 3 (3.1) |
Missing | 1 (1.0) |
Total | 98 (100.0) |
Treatment regimen: | |
Category 1 | 94 (95.9) |
Category 2 | 4 (4.1) |
Total | 98 (100.0) |
Antiretroviral treatment status | |
On treatment | 46 (46.9) |
Not on treatment | 52 (53.1) |
(36.7%) while 15% of them (mainly children) were unable to produce sputum. Majority of the patients (95.9%) received category 1 anti-Kochi’s regimen as against category 2 regimen (4.1%). Most of them (53.1%) were not on treatment for HIV infection as against those on treatment (46.9%).
Variables | Male (N = 48) | Female (N = 50) | Total | X2 | p Value |
---|---|---|---|---|---|
n(%) | N (%) | ||||
Age groups (years) | |||||
<20 | 16 (33.3) | 8 (16.0) | 24 (24.5) | 12.869 | 0.025* |
20 - 29 | 1 (2.1) | 9 (18.0) | 10 (10.2) | ||
30 - 39 | 14 (29.2) | 20 (40.0) | 34 (34.7) | ||
40 - 49 | 14 (29.2) | 8 (16.0) | 22 (22.4) | ||
50 - 59 | 3 (6.2) | 4 (8.0) | 7 (7.1) | ||
60 - 69 | 0 (0.0) | 1 (2.0) | 1 (2.0) | ||
Weight (kg) | |||||
<20 | 8 (16.7) | 4 (8.0) | 12 (12.2) | 14.986 | 0.036* |
20 - 29.9 | 5 (10.4) | 2 (4.0) | 7 (7.1) | ||
30 - 39.9 | 1 (2.1) | 3 (6.0) | 4 (4.1) | ||
40 - 49.9 | 5 (10.4) | 17 (34.0) | 22 (22.4) | ||
50 - 59.9 | 15 (31.2) | 14 (28.0) | 29 (29.6) | ||
60 - 69.9 | 7 (14.6) | 9 (18.0) | 16 (16.3) | ||
70 - 79.9 | 6 (12.5) | 1 (2.0) | 7 (7.1) | ||
999 | 1 (2.1) | 0 (0.0) | 1 (1.0) | ||
Residence | |||||
Urban | 33 (68.8) | 28 (56.0) | 61 (62.2) | 1.694 | 0.193 |
Rural | 15 (31.2) | 22 (44.0) | 37 (37.8) | ||
Site of disease | |||||
Pulmonary | 43 (89.6) | 47 (94.0) | 90 (91.8) | 0.637 | 0.425 |
Extrapulmonary | 5 (10.4) | 3 (6.0) | 8 (8.2) | ||
Sputum AFB status | |||||
Positive | 17 (36.2) | 19 (38.0) | 36 (37.1) | 3.161 | 0.367 |
Negative | 18 (38.3) | 25 (50.0) | 43 (44.3) | ||
Unable to produce sputum | 10 (21.3) | 5 (10.0) | 15 (15.5) | ||
Others | 2 (4.3) | 1 (2.0) | 3 (3.1) | ||
Antiretroviral treatment status | |||||
On treatment | 21 (43.8) | 25 (50.0) | 46 (46.9) | 0.384 | 0.535 |
Not on treatment | 27 (56.2) | 25 (50.0) | 52 (53.1) | ||
Treatment Regimen | |||||
Category 1 | 46 (95.8) | 48 (96.0) | 94 (95.9) | 0.002 | 0.967 |
Category 2 | 2 (4.2) | 2 (4.0) | 4 (4.1) |
*Statistically significant.
Variables | Urban (N = 61) n (%) | Rural (N = 37) n (%) | Total | X2 | p Value |
---|---|---|---|---|---|
Sex | |||||
Male | 33 (54.1) | 15 (40.5) | 48 (49.0) | 1.694 | 0.193 |
Female | 28 (45.9) | 22 (59.5) | 50 (51.0) | ||
Age | |||||
<20 | 13 (21.3) | 11 (29.7) | 24 (24.5) | 3.439 | 0.633 |
20 - 29 | 6 (9.8) | 4 (10.8) | 10 (10.2) | ||
30 - 39 | 24 (39.3) | 10 (27.0) | 34 (34.7) | ||
40 - 49 | 14 (23.0) | 8 (21.6) | 22 (22.4) | ||
50 - 59 | 4 (6.6) | 3 (8.1) | 7 (7.1) | ||
60 - 69 | 0 (0.0) | 1 (2.7) | 1 (1.0) | ||
Weight (kg) | |||||
<20 | 5 (8.2) | 7 (18.9) | 12 (12.2) | 6.507 | 0.482 |
20 - 29.9 | 4 (6.6) | 3 (8.1) | 7 (7.1) | ||
30 - 39.9 | 3 (4.9) | 1 (2.7) | 4 (4.1) | ||
40 - 49.9 | 14 (23.0) | 8 (21.6) | 22 (22.4) | ||
50 - 59.9 | 16 (26.2) | 13 (35.1) | 29 (29.6) | ||
60 - 69.9 | 12 (19.7) | 4 (10.8) | 16 (16.3) | ||
70 - 79.9 | 6 (9.8) | 1 (2.7) | 7 (7.1) | ||
Missing | 1 (1.6) | 0 (0.0) | 1 (1.0) | ||
Site of disease | |||||
Pulmonary | 55 (90.2) | 35 (94.6) | 90 (91.8) | 0.603 | 0.437 |
Extrapulmonary | 6 (9.8) | 2 (5.4) | 8 (8.2) | ||
Sputum AFB Status | |||||
Positive | 21 (35.0) | 15 (40.5) | 36 (37.1) | 2.077 | 0.557 |
Negative | 27 (45.0) | 16 (43.2) | 43 (44.3) | ||
Unable to produce sputum | 9 (15.0) | 6 (16.2) | 15 (15.5) | ||
Others | 3 (5.0) | 0 (0.0) | 3 (3.1) | ||
Antiretroviral treatment status | |||||
On treatment: | 30 (49.2) | 16 (43.2) | 46 (46.9) | 0.326 | 0.568 |
Not on treatment | 31 (50.8) | 21 (56.6) | 52 (53.1) | ||
Treatment regimen | |||||
Category 1 | 59 (96.7) | 35 (94.6) | 94 (95.9) | 0.266 | 0.606 |
Category 2 | 2 (3.3) | 2 (5.4) | 4 (4.1) |
*Statistically significant.
Variables | Pulmonary N = 90 n% | Extrapulmonary N = 8 n% | Total | X2 | p Value |
---|---|---|---|---|---|
Sex | |||||
Male | 43 (47.8) | 5 (62.5) | 48 (49.0) | 0.637 | 0.425 |
Female | 47 (52.2) | 3 (37.5) | 50 (51.0) | ||
Age: | |||||
<20 | 21 (23.3) | 3 (37.5) | 24 (24.5) | 3.174 | 0.673 |
20 - 29 | 10 (11.1) | 0 (0.0) | 10 (10.2) | ||
30 - 39 | 30 (33.3) | 4 (50.0) | 34 (34.7) | ||
40 - 49 | 21 (23.3) | 1 (12.5) | 22 (22.4) | ||
50 - 59 | 7 (7.8) | 0 (0.0) | 7 (7.1) | ||
60 - 69 | 1 (1.1) | 0 (0.0) | 1 (1.0) | ||
Weight category | |||||
<20 | 11 (12.2) | 1 (12.5) | 12 (12.2) | 15.611 | 0.029* |
20 - 29.9 | 6 (6.7) | 1 (12.5) | 7 (7.1) | ||
30 - 39.9 | 4 (4.4) | 0 (0.0) | 4 (4.1) | ||
40 - 49.9 | 21 (23.3) | 1 (12.5) | 22 (22.4) | ||
50 - 59.9 | 25 (27.8) | 4 (50.0) | 29 (29.6) | ||
60 - 69.9 | 16 (17.8) | 0 (0.0) | 7 (7.1) | ||
70 - 79.9 | 7 (7.8) | 0 (0.0) | 7 (7.1) | ||
Sputum AFB Status | |||||
Positive | 36 (40.0) | 0 (0.0) | 36 (37.1) | 5.121 | 0.163 |
Negative | 38 (42.2) | 5 (71.4) | 43 (44.3) | ||
Unable to produce sputum | 13 (14.4) | 2 (28.6) | 15 (15.5) | ||
Others | 3 (3.3) | 0 (0.0) | 3 (3.1) | ||
Antiretroviral treatment status | |||||
On treatment: | 42 (46.7) | 4 (50.0) | 46 (46.9) | 0.033 | 0.856 |
Not on treatment | 48 (53.3) | 4 (50.0) | 52 (53.1) | ||
Treatment Regimen | |||||
Category 1 | 86 (95.6) | 8 (10.0) | 94 (95.9) | 0.371 | 0.543 |
Category 2 | 4 (4.4) | 0 (0.0) | 4 (4.1) | ||
Residence | |||||
Urban | 55 (61.1) | 6 (75.0) | 61 (62.2) | 0.603 | 0.437 |
Rural | 35 (38.9) | 2 (25.0) | 37 (37.8) |
*Statistically significant.
In this study there were more female than male TB/HIV co-infected patients. This is similar to the finding of a study done at Enugu, Nigeria where there were more female TB/HIV co-infected patients [
In this study there were more urban patients than rural patients. This contrasts with the findings of a study
Variable | Positive N = 35 n (%) | Negative N = 43 n (%) | Unable to produce N = 15 n (%) | Others N = 3 n (%) | Total | X2 | p Value |
---|---|---|---|---|---|---|---|
Age | |||||||
<20 | 1 (2.8) | 9 (20.9) | 13 (86.7) | 1 (33.1) | 24 (24.7) | 48.156 | 0.000* |
20 - 29 | 5 (13.9) | 5 (11.6) | 0 (0.0) | 0 (0.0) | 10 (10.3) | ||
30 - 39 | 15 (41.7) | 16 (37.2) | 1 (6.7) | 1 (33.3) | 33 (34.0) | ||
40 - 49 | 13 (5.6) | 8 (18.6) | 1 (6.7) | 0 (0.0) | 22 (227) | ||
−50 - 59 | 2 (5.6) | 4 (9.3) | 0 (0.0) | 1 (33.3) | 7 (7.2) | ||
60 - 69 | 0 (0.0) | 1 (2.3) | 0 (0.0) | 0 (0.0) | 1 (1.0) | ||
Weight | |||||||
<20 | 0 (0.0) | 1 (2.3) | 11 (73.3) | 0 (0.0) | 12 (12.4) | 77.767 | 0.000* |
20 - 29.9 | 0 (0.0) | 5 (11.6) | 1 (6.7) | 1 (33.3) | 7 (7.2) | ||
30 - 39.9 | 1 (2.8) | 3 (7.0) | 0 (0.0) | 0 (0.0) | 4 (4.1) | ||
40 - 49.9 | 7 (2.8) | 12 (27.9) | 2 (13.3) | 1 (33.3) | 22 (22.7) | ||
50 - 59.9 | 14 (38.9) | 13 (30.2) | 1 (6.7) | 0 (0.0) | 28 (28.9) | ||
60 - 69.9 | 9 (25.0) | 6 (14.0) | 0 (0.0) | 1 (33.3) | 16 (16.5) | ||
70 - 79.9 | 5 (13.9) | 2 (4.7) | 0 (0.0) | 0 (0.0) | 7 (7.2) | ||
Residence | |||||||
Urban | 21 (58.3) | 27 (62.6) | 9 (60.0) | 3 (100.0) | 60 (61.9) | 2.077 | 0.557 |
Rural | 15 (51.7) | 16 (37.2) | 6 (40.0) | 0 (0.0) | 37 (38.1) | ||
Site of disease | |||||||
Pulmonary | 36 (100.0) | 38 (88.4) | 13 (86.7) | 3 (100.0) | 90 (92.8) | 5.121 | 0.163 |
Extrapulmonary | 0 (0.0) | 5 (11.6) | 2 (13.3) | 0 (0.0) | 7 (7.2) | ||
Antiretroviral treatment status | |||||||
On treatment: | 20 (55.6) | 21 (48.8) | 3 (20.0) | 1 (33.3) | 45 (46.4) | 5.726 | 0.126 |
Not on treatment | 16 (44.4) | 22 (51.2) | 12 (80.0) | 2 (66.7) | 52 (53.6) | ||
Treatment Regimen | |||||||
Category 1: | 34 (94.4) | 41 (95.3) | 15 (100.0) | 3 (100.0) | 93 (95.9) | 0.991 | 0.803 |
Category 2: | 2(5.6) | 2(4.7) | 0(0.0) | 0(0.0) | 4(4.1) |
*Statistically significant.
done in Pakistan [
In this study, there were more female TB/HIV patients. The reproductive age group was more affected. There were more pulmonary TB patients than extra-pulmonary TB patients. There were more sputum AFB negative patients.
We therefore recommend as follows: there should be more rigorous case finding of TB/HIV co-infection among females. More efforts to combat TB/HIV co-infection should be channelled towards the reproductive age group. Health workers should not be in a hurry to conclude that sputum smear negative HIV patients did not have TB. Clinical diagnosis of tuberculosis in a background of tuberculosis should be intensified. Health workers should be wary of the presence of TB in HIV positive individuals. Efforts should be made to prevent HIV among youths. Adolescent friendly clinics should be established. Efforts to combat TB/HIV co-infection should be intensified in the urban areas, in as much as the rural areas should not be neglected.
Echendu D.Adinma,Darlington C.Obi,Emmanuel C.Azuike,Victor A.Mbanuzuru,Ifeoma C.Iloghalu, (2015) Characterization of TB/HIV Co-Infected Patients Receiving TB Treatment at a DOTS Clinic, in a Tertiary Hospital in South-Eastern Nigeria. Journal of Tuberculosis Research,03,113-121. doi: 10.4236/jtr.2015.34017