Human immunodeficiency virus- associated tuberculosis: pattern and trend in the University of Ilorin Teaching Hospital

Abstract

To define the incidence and spectrum of extra pulmonary tuberculosis (EPTB) and the trend of pulmonary tuberculosis (PTB) among human immunodeficiency virus (HIV) infected patients in the University of Ilorin teaching hospital, a tertiary care centre in Nigeria. Review of all PTB cases diagnosed by Ziehl-Neelsen staining technique and EPTB diagnosed by tissue histology and/or cytology between January 2000 and December 2004. HIV/TB co-infection occurred in 40% (297 cases) of the 744 new cases of tuberculosis (TB) seen in the last 5 years, HIV/PTB occurred in 79% and HIV/EPTB occurred in 21%. About 47 new cases of HIV/PTB and 12 of HIV/EPTB were diagnosed per year. Tuberculous pleurisy with effusion; 23%, tuberculous meningitis; 16% and genital tuberculosis; 10% as (tuberculous: orchitis, endometritis and frozen pelvis) were common form of extra pulmonary presentation. The chance of mixed presentation was 3 times higher amongst the HIV positive than HIV negative patients; 27 vs. 11: X2: = 6.99. OR 3.25; 95% CI=1.32-8.14, p-value= 0.008. Similarly, the chance of miliary tuberculosis was 4 1/2 times higher in the HIV positive group; 9 vs. 2: X2= 4.29, OR 4.67; 95% CI= 0.90-45.93, p-value= 0.03. Both conditions recorded the lowest CD4+ cells count; 88cells/ul and 93.6.6cells/ul, thus serving as features of advanced HIV illness. PTB and EPTB are commo n amongst the HIV infected patients; miliary spread and mixed presentation are signs of severe immunosuppression.