A Study on Pulmonary Tuberculosis in HIV Reactive Persons

INTRODUCTION : Tuberculosis, an ancient disease, continues to remain even today as a major public health problem in much of the developing countries like India. The Problem is now complicated by relentless spread of Human Immunodeficiency virus (HIV) which causes Acquired Immunodeficiency syndrome (AIDS) pandemic and the emergence of multi drug resistant strains. Infection with HIV results in progressive immunodeficiency and renders the infected person become increasingly vulnerable to wide range of pathogens. In many parts of the world Tuberculosis is the most common opportunistic infection in HIV infected person. The immune defects produced by HIV influence the natural course of TB infection. Thus the HIV pandemic has altered both the epidemiology of TB and measures for approaches to its control. In populations where the risk of TB and HIV infections are high, the incidence of TB is expected to increase particularly in countries like India. In this study, an attempt has been made to study the Clinical Spectrum, laboratory and radiological changes in patients having pulmonary TB in HIV Patients. AIMS OF THE STUDY : 1. To study the clinical spectrum of pulmonary TB and HIV patients attending our Medical college Hospital. (both inpatients and outpatients). 2. To study the laboratory and radiological changes in the above said patients. 3. To evaluate the diagnostic limitations of tuberculin test and sputum smear microscopy for AFB in patients having tuberculosis infection in HIV. MATERIALS AND METHODS : The study was conducted in the Antiretroviral therapy (ART) op in Government Mohan Kumaramangalam Medical College Hospital, Salem in 2005. Inclusion Criteria : 1. Patients included in the age group between 12 and 60. 2. Patients with CD4+ cells counts with less than or equal to 200 cells per mm3 ( < 200 ). 3. Newly diagnosed cases of pulmonary TB in HIV patients. 4. Both sputum positive and sputum negative with X-ray and clinical evidence of PTB in HIV positive patients. 5. Patients having pulmonary manifestations only. Exclusion Criteria : 1. Patients with age group of 60. 2. Patients with CD4+ cell counts more than 200 cells per mm3 (> 200). 3. Patients having only extrapulmonary manifestation like, pleural effusion, lymphadenopathy, Meningitis etc. 4. Patients having chronic ailements like CRF, Diabetes Mellitus, CCF, Stroke etc. Methods : In this study, the eligible patients attending both medicine OPD and ART OP were evaluated in the following way. (a) Detailed History taking. (b) Physical examination. (c) Laboratory examinations which includes complete hemogram, blood biochemistry, Sputum smears, X – ray chest, CD4+ cell count, Tuberculin test and LFT, if needed USG abdomen and CT scan. The details are collected in a Proforma. CONCLUSION : a) In our part of the world Tuberculosis is the common opportunistic infection even in advanced stages of HIV infection. b) It commonly affects male in the productive age groups (21 to 40). c) Most of the patients in advanced stages usually present with more than 3 of the 5 clinical features such as cough with expectoration, dyspnoea, fever, weight loss and hemoptysis. d) Oral thrush is present in about 35% patients which serves as an indicator of severity of disease (HIV infection). e) Patients with Tuberculosis in HIV positive persons can present with normal X-ray even in advanced stages of HIV disease also. Hence presence of normal X-ray does not rule out the possibility of Tuberculosis in HIV patients. f) Patients in later stages of HIV infection usually present with atypical radiological patterns such as lower zone infiltrates, mid zone and lower zone cavities, pleural effusions, and hilar / paratracheal lymphadenopathy although classical upper zone infiltrates and cavities occur in less than 25 to 30% of patients. g) Majority of the patients (42%) were in the CD4+ cell counts range of 100 to 200 Cells / mm3. With the conventional sputum positivity and if Tuberculin test not providing an adequate diagnostic help, familiarity with the clinico – radiological spectrum of Tuberculosis is absolutely necessary