After the detection and recognition of HIV in 1983, the declining curve of TB infection started to show a sudden rise during the 1990s. Coinfection with TB and HIV has already been reported as one of the most significant global public health concerns.[6
] Tuberculosis is the commonest opportunistic disease in HIV positive persons in India.[1
] HIV/AIDS pandemic has caused a resurgence of TB, resulting in increased morbidity and mortality worldwide.[7
] From the epidemiological point of view, our TB/HIV patients differed in some respects from those present in other parts of the world.
Most of our study group patients (76%) belonged to the age group of 21–40 years, which is the sexually active age and is also the most productive in one’s life. Of all the detected patients, 82% were males and the rest were females. The striking male predominance noted in the present study has also been reported by other authors.[8
] The occupational profile of our patients revealed that a majority of them were farmers and laborers followed by transport drivers. Mohanty et al
] reported 36.8% patients working as manual laborers while Rajsekaran et al
] found majority (55.6) of patients working as farmer. Other authors[9
] have found sero-positivity rate was highest among those who were unemployed (40%) followed by the business professionals (35%). The percentage of the professions is thus seen to vary in different studies, largely due to the differences in the occupational patterns and the source from where the patients were selected.
Sexual route (heterosexual) was found to be the major risk factor (86%) while only one patient was an intravenous drug abuser and one patient was homosexual in our study. Three patients (6%) had blood-transfusion-related transmission. Heterosexual promiscuity and casual sex was found to be a major risk factor in the studies by some Indian observers[10
] while other[9
] observed that the majority of their cases were intravenous drug abusers (68.9%).
The average duration of symptoms was 12.2 weeks, indicating that there was a delay in diagnosing tuberculosis and starting treatment. Whether the delay was at the patient or provider level needs further investigation. The duration of illness in our patients ranged from 2 weeks to 2 years. Swaminathan et al
] found that the duration of illness in their cases before seeking treatment was 12 weeks.
Tuberculin test positivity (>10 mm) to 5 TU PPD was observed in 32.14% patients in our study. Other authors have reported a wide variation in tuberculin test positivity.[9
] Positive response to tuberculin is generally retained early in the course of HIV infection.
The most common symptom was cough in 47 (94%) patients, while fever was present in 43 (86%) and weight loss in 39 (78%) patients. In the series reported by Mohanty et al
] fever was the most common complaint, while Deivanayagam et al
] reported cough with expectoration in majority of their patients.
Eleven (25.58%) of our patients had sputum smear for AFB positive. This is very different from the situation in HIV uninfected tuberculosis patients and indicates that smear microscopy is not a sensitive diagnostic tool in the presence of HIV infection. Mohanty et al
] has reported 31.59% while Deivanayagam et al
] has reported 15% patients as smear positive. It has been shown that sputum smear is often positive in the early stage of HIV infection.[4
Extra-pulmonary tuberculosis is more common in HIV/TB patients, especially with advanced immunesuppression than in non-HIV/TB patients.[4
] Extra-pulmonary tuberculosis was seen in 30 (60%) of our HIV/TB patients. Most common form of extra-pulmonary TB was mediastinal lymphadenopathy followed by pleural effusion and extra-thoracic adenopathy. Overall involvement of lymphatic system was seen in 21 (42%) patients. Other authors have also observed that lymphatic system is the most commonly involved, followed by pleural involvement in HIV/TB patients.[4
Twenty-three patients (53.49%) out of 43 PTB patients had an associated extra-pulmonary focus, and two patients with extra-pulmonary TB had multisystem involvement which is pointing to the disseminated nature of the disease in HIV positive.
We conclude that HIV/TB coinfection is more common in sexually active age group and heterosexual transfer is the commonest mode of HIV infection. Sputum smear AFB and Mantoux test positivity is low in TB patients having HIV. Disseminated TB is common in HIV and mediastinal lymphadenopathy is common site among extra-pulmonary tuberculosis.