Pulmonary Tuberculosis co-infection among HIV infected persons in and around District of Erode, Tamil Nadu, India

Introduction AIDS is the commonest cause of death affecting 40 million people worldwide. HIV infection leads to an immunocompromised state in the affected persons who are more sensitive for opportunistic infections caused by bacteria, fungi, viruses and parasites. In developing and developed countries, tuberculosis (TB) caused by Mycobacterium tuberculosis is a major opportunistic infection. In India about 1.8 million new cases of TB have been recorded annually accounting for a fifth of new cases in the world (Steinbrook, 2007). One third of tuberculosis patients also have HIV infection. Both the diseases interact on each other and worsen the prognosis and increase the mortality (Bevilacqua et al., 2002). The high prevalence of active TB in AIDS patient was first noticed by Viera et al., (1983). It may be difficult to diagnose the patients with HIV and TB if the HIV status of the patient is not known. ISSN: 2319-7706 Volume 2 Number 5 (2013) pp. 1-7 http://www.ijcmas. com K e y w o r d s HIV; Pulmonary Tuberculosis; co-infection. To find out HIV infectivity, totally 775 serum samples were analysed from persons between 50 years age group who attended Perundurai medical college hospital, Erode. Out of 775 samples, 126 (16.26%) samples, 81(10.45 %) males and 45 (5.81 %) females were HIV positive. Patients (45.2 %) at the age group 3039 years were severely affected. Daily wages (25.40 %) showed high infectivity followed by drivers (20.63 %). Mainly heterosexual route was found to be the major risk factor for AIDS. When all 126 HIV patients were tested for Mycobacterium tuberculosis infection, 38 (30.16 %) patients, 30 (23.81 %) males and 8(6.35 %) females showed positive result. HIV and TB co-infection was mainly observed in patients (42.10%) at the age group of 30-39 years. Daily wages (28.95 %) followed by drivers (18.42 %) were severely affected. The results of the study suggest that proper screening of HIV infected at earliest for TB since TB may influence rapid progression to AIDS if left untreated. Int.J.Curr.Microbiol. App.Sci (2013) 2(5): 1-7 2 Symptoms such as fever, night sweat and recent weight loss may be noticed in the patients but are not specific for TB. The exact mechanism and interaction by which tuberculosis accelerates the progression of HIV disease remain unclear. The coinfection of HIV and TB in India varies widely and many studies have been reported increasing rates reflecting the spread of HIV in the general population (Paranjape et al., 1997., Khare et al., 2001; Chakaya et al., 2008). The objective of this study was to find out the HIV infectivity and the prevalence of pulmonary tuberculosis among HIV infected patients in and around Erode district, Tamilnadu, India. Materials and Methods A total of 775 clinically suspected cases of AIDS with different age groups from different regions of Erode and its surroundings attending Perundurai Medical College Hospital, Tamilnadu, India were analysed. From the persons after counseling, informed consent and detailed history including social background, drug abuse, sexual risk behaviour and blood transfusion were obtained prior to sample collection. About 2 mL of blood was collected aseptically and allowed to clot . Serum was separated by centrifugation and tested for antibodies to HIV I and HIV II by using commercial ELISA kits. Samples of all patients which were positive in the initial screening test done by HIV TRIDOT ELISA kit (J. Mitra & Co, New Delhi, India) were retested by EIA comb kit (Cambridge Biotech, Maryland, USA) to avoid false positive result. From the confirmed HIV positive patients, sputum was collected and examined for the presence of acid fast bacilli by conventional Zeihl-Neelson staining technique. Radiological analysis and culture method using LowensteinJenson medium were also used to diagnose pulmonary tuberculosis in acid fast bacilli negative smear cases. Results and Discussion Of the 775 serum samples analysed, totally 126 persons 81 (10.45 %) males and 45 (5.81 %) females had HIV infection. Among them patients at the age group of 30-39 years showed high infectivity (45.24 %) followed by 40-49 years age group patients (23.81 %) as shown in table 1. As table 2 shows the mainly affected were daily wages (25.40%) followed by drivers (20.63%). When the mode of acquisition of infection was ascertained in all 126 HIV infected patients, 115 (91.27%) became infected with HIV through heterosexual contact, 6(4.76%) through blood transfusion and 5 (3.97%) due to parent to child transmission, No one was infected with syringe and needle (Table 3). Pulmonary tuberculosis (PTB) in HIV positive patients were confirmed by sputum staining, culture test and radiological reports. As given in table 4, totally 38 (30.16 %) patients, 30 (23.81 %) males and 8(6.38 %) females showed HIV/AIDS and TB co-infection. They were mainly at the age group of 30-39 years, 11(36.66 %) males and 5 (62.50 %) females. Mainly daily wages (28.95%) and drivers (18.42 %) had both the diseases (Table 5). The study results showed sexually active age group persons especially daily wages and drivers between 30 49 years involving in various work activities have been affected. Similar results have been already reported (Kumar et al., 2002). In contrast to this result, farmers to maximum Int.J.Curr.Microbiol. App.Sci (2013) 2(5): 1-7 3 Table.1 Age / sex distribution of HIV positive cases HIV positive cases Age No. of HIV suspected cases Males Females Total Less than 14