Profile of HIV associated tuberculosis at a tertiary institute in setting of free anti-retroviral therapy.

Abstract

SETTING: With the rollout of the national program, free of cost antiretroviral therapy is available to the Indian population since 2004, resulting in sea change in outcome of HIV associated tuberculosis. OBJECTIVE: To assess the presentation and outcome in patients being treated for concurrent TB and HIV. DESIGN: Retrospective analysis of data from standardized patient records. RESULTS: Seventy-three (29.1%) of the 251 HIV infected patients, who reported to the ART centre at LRS Institute of TB and Respiratory Diseases, New Delhi, between January 2006 and June 2007, were diagnosed with concurrent active tuberculosis. The mean CD4 count at presentation was 108.2 cells/microl and 87.6% patients had CD4 counts less than 200 cells/microl. 38.4% patients had purely pulmonary tuberculosis, 39.7% had purely extra-pulmonary tuberculosis and 21.9% had both. Sputum positivity in those with pulmonary involvement was 34.1%. Immune reconstitution inflammatory syndrome was seen in 20.5% patients. 67.2% patients had a favorable outcome (cure and treatment completed). 17.8% case fatality was observed in the study period. CONCLUSION: Despite severe immune suppression, treatment with ATT and ART leads to an improved outcome in patients with concurrent HIV and TB.