Impact of tuberculosis and long term benefits of anti-retroviral treatment in patients with HIV in Sri Lanka

Introduction: Although prevalence of HIV infection in Sri Lanka is low, there is a gradual increase in incidence. Effective anti-retroviral treatment (ART) controls the virus, improves immunity and reduces transmission of HIV greatly.

Objective: We studied the impact of tuberculosis and response to ART in a cohort of patients with HIV in Sri Lanka.

Methodology: A retrospective study of all patients with HIV followed up at the ART clinic at National Institute of Infectious Diseases, Angoda, Sri Lanka was carried out. Their socio-demographic data, clinical presentations, anti-retroviral treatment and clinical, immunological and virological response were analysed.

Results: Study included 72 patients. Mean age was 47.19 (SD-10.354) years. Male to female ratio was 1:0.8. Forty nine (68%) patients were diagnosed with HIV after presenting with an opportunistic infection. Of these, 25 had tuberculosis (TB). Another 5 developed TB later. Fifty two (72.2%) had CD4 cell counts<200/μl which included 45(62.5%) who had CD4<100/μl. Twenty six (36.1%) patients were bed ridden and a further 6 (8.3%) were physically dependent at the time of diagnosis. Mean duration of ART was 82.4 months. With ART, CD4 cell counts and mobility improved. In 38 (52.8%) CD4 counts increased to more than 500/μl. Viral load became undetectable in 62 (86.1%). Sixty nine (95.8%) became completely physically independent.

Conclusion: TB is a common co-infection in patients with HIV in Sri Lanka. Though many patients with HIV presented with poor immunological and physical status, ART markedly improved these outcomes and reduced the viral load which results in prevention of spread of HIV. Therefore, ART should be supported and encouraged