CLINICO-RADIOLOGICAL PRESENTATION OF PULMONARY TUBERCULOSIS IN HIV POSITIVE PATIENTS IN A TERTIARY CARE HOSPITAL OF EASTERN INDIA

INTRODUCTION:   The deadliest combination of the two devastating and killer disease TB & HIV has been closely linked since the emergence of AIDS contributing the progress and pathogenecity of each other, and As half of the HIV  patients are likely to be infected with tuberculosis, the twin challenge of this “CURSED DUET” seems to be daunting 1 . There has been increase rate of DR TB, MDR TB, XDR TB, which are difficult to treat and contribute to increase mortality. In a developing country like India, the potential extra burden of new tuberculosis cases attributable to HIV is staggering and could overwhelm the already stretched tuberculosis budgets and support services. AIMS & OBJECTIVES:  To study and co-relate clinical and radiological features of  Pulmonary TB in HIV positive patients, comparision with degree of immunosuppression. To compare the CD 4 T-cell count and sputum status before and after ATT treatment completion. MATERIALS & METHODS: This is a prospective cohort  study  conducted on 51 patients admitted to Department of Pulmonary Medicine, S.C.B. Medical College, Cuttack from September 2011 to august 2013.  The patients included in the study were all TB patients of age >15 years with strong clinical suspicion of HIV/AIDS. Pulmonary TB was diagnosed either with sputum smear positive or Chest x-ray. When EPTB was suspected as a possible diagnosis, every attempt was made to procure tissue/relevant body fluid for diagnostic testing. Rapid tests are in vitro qualitative tests for the detection of antibodies to Human Immunodeficiency Virus(HIV) types 1 &2 in human serum, plasma, whole blood, urine, saliva  was used for diagnosis of HIV. Patients with only extra Pulmonary Tuberculosis and no evidence of pulmonary tuberculosis and Patients with PCP, fungal infection and sepsis were not included because these conditions cause lymphopenia and decreases CD 4 T-cell count. RESULTS: Out of these 51 patients, most of the HIV-TB co-infected patients (62.5%) were seen among sexually active age group of 25-44 yrs. 92% of the patients were male and 8% were females. Most frequently encountered symptoms were fever(78.5%), cough (72.5%), loss of appetite(68.5%) and loss of weight(66.5%). Most common non-respiratory sign was pallor (67%), oral thrush(21.5%), lymphadenopathy(17.5%) and most common respiratory sign was crepitations (49%). B/L involvement was seen in 55% cases. About 74.5% cases were moderately or far advanced disease on the chest radiograph. The typical radiological findings of post primary TB, i.e. upper zone infiltrate, fibrosis and cavities were found in 25%, 4% and 6% cases respectively. Pleural effusion was detected in 10%, pneumothorax in 2% and hydropneumothorax in 2% cases. In our case 33% of the patients had CD4 count 0-50, 27.5% had CD4 count 51-100, 19.5% had CD4 count 101-150, 12% had CD4 count 151-200 and only 8% had CD4 count above 200. Comparing CD4 count with radiological findings infiltration and military tuberculosis were distributed over all ranges of CD4 counts. Cavitary lesions were more in CD4 count above 100. Overall sputum positive PTB was 74.5% and sputum negative PTB was 25.5%. Treatment outcome in sputum positive patients were cured in 63%, death in 23.5%, failure in 8% and defaulter in 5.5%. In patients with sputum smear negative PTB treatment completed were 69.5%, death occurred in 15.5%, defaulter and failure was seen in 7.5% each. CONCLUSION: Treatment of HIV-TB co infection requires strong commitment and a focused approach. A strong coordination between the national TB and AIDS control programmes is required for effective management of TB-HIV patients.