Proportion and determinants of tuberculosis among human immunodeficiency virus-positive patients attending the antiretroviral therapy center attached to a Medical College in South India.

BACKGROUND: The human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) pandemic has caused a re-emergence of tuberculosis (TB). In persons infected with both HIV and TB, the lifetime risk of developing TB disease is 50-70% compared to 10% in HIV-negative individuals. India has world's 3(rd) highest HIV burden and is also one of the countries endemic for TB, so the country faces a dual epidemic of HIV and TB.

OBJECTIVES: To find out the proportion and determinants of TB in HIV-positive subjects.

SUBJECTS AND METHODS: This study was undertaken at the ART center from June 01, 2012, to May 31, 2013. HIV-positive subjects aged above 15 years who had been on antiretroviral therapy (ART) for more than 6 months were included in the study. Nonprobability purposive sampling was adopted. A predesigned semi-structured questionnaire was used to obtain data.

RESULTS: A total of 536 HIV-positive people were interviewed, 58.8% of whom were males, 79.1% were Hindu, 61.0% had up to high school education, and 57% were unskilled laborers. About 63% were married, 40% were from the upper lower class, and 60% were from urban areas. For the majority (89.1%), the probable mode of transmission of HIV was by the heterosexual route. TB co-infection was present in 38.4% subjects. The most common form of TB was extra-pulmonary in subjects on antituberculous treatment (47.3%) and among old cases (57.6%). On bivariate analysis, 136 (42.4%) married subjects and those from rural areas were more commonly affected by TB compared to subjects who were unmarried and from urban areas with odds ratio (OR): 1.555, confidence interval (CI): 1.077-2.246 and OR: 1.523, CI: 1.061-2.185, respectively. The proportion of TB was high among subjects who lived in overcrowded houses 130 (44.2%), and who had a habit of alcohol use compared to others with OR: 1.731, CI: 1.734-2.179 and OR: 1.524, CI: 1.045-2.223, respectively. Logistic regression analysis showed that TB among people living with HIV/AIDS was highest in persons living in overcrowded houses (OR: 1.706, CI: 1.185-2.458) and those who consumed alcohol (OR: 1.605, CI: 1.090-2.362).

CONCLUSIONS: Demographic factors like male gender, middle age, living in the rural areas, consumption of alcohol, and living in overcrowded houses were found with a higher proportion of TB. The use of highly active ART appeared to progressively decrease but did not completely eliminate the risk of TB.