Clinico-epidemiological determinants of tuberculosis co-infection among adults attending an antiretroviral centre at a tertiary care hospital in Madhya Pradesh

Abstract

Background: The co-infection of human immunodeficiency virus-tuberculosis (HIV-TB) is a serious public health concern and aptly called the 'deadly duo'. Recognising the determinants of the co-infection will help target the vulnerable population for prevention and reduce mortality. Aims: The objective of this study was to estimate the proportion of HIV-TB co-infection among adults attending the antiretroviral therapy (ART) centre at a tertiary healthcare facility and associated clinico-epidemiological determinants. Patients and Methods: A cross-sectional analytical research that lasted for 6 months was conducted at the ART Centre of Medical College, Gwalior, Madhya Pradesh. According to the inclusion criteria, 251 newly diagnosed HIV patients were enrolled in the study. The pro forma administered by the interviewer was utilised to collect the socio-demographic information at the time of enrolment by face-to-face interviews. To gather the clinical details, records were reviewed. A Chi-square test of significance was used to determine the difference between proportions after descriptive analysis. Variables found significant in bivariate analysis were put in multivariate logistic regression to predict HIV-TB co-infection. The odds ratio was estimated at 95% confidence interval (CI). Results: Among the participants, 27.5% of the 251 people had both TB and HIV. Males who were employed as labourers (X2 = 25.5, df = 4 and P = 0.001) were epidemiologically more likely to get co-infection. In comparison to the other group of HIV-only patients, the CD4+ count of co-infected individuals was considerably lower (X2 = 6.37, df = 3 and P < 0.01). Clinical staging of HIV (adjusted odds ratio [aOR] =4.70, 95% CI 2.34–9.43; P = 0.001), body mass index (aOR = 0.46, 95% CI 0.013; P = 0.25–0.85) and CD4+ count (aOR = 0.22, 95% CI 0.08–0.60; P = 0.003) were found to predict HIV-TB co-infection among people living with HIV (PLHIV). Conclusion: The study concludes, being underweight with an advanced clinical staging (World Health Organisation Clinical Stage III or IV of HIV) and a CD4+ count equal to or below 300 cells/μL increase the vulnerability of HIV-TB co-infection among adult PLHIV.

Keywords

• antiretroviral
• human immunodeficiency virus
• human immunodeficiency virus-tuberculosis
• tuberculosis
• tuberculosis-human immunodeficiency virus co-infection