|Year : 2013 | Volume
| Issue : 2 | Page : 140-143
HIV sero-prevalence among adult with newly diagnosed pulmonary tuberculosis in Kano, Nigeria
Mohammed Yusuf1, Oyebanji Azeez-Akande1, Muhammad Yusha置2
1 Department of Medical Microbiology and Parasitology, Faculty of Medicine, Bayero University, P. M. B 3011, Kano, Nigeria
2 Department of Microbiology, Faculty of Science, Bayero University, P. M. B 3011, Kano, Nigeria
|Date of Web Publication||24-Dec-2013|
Department of Medical Microbiology and Parasitology, Faculty of Medicine, Bayero University, P. M. B 3011, Kano
Source of Support: None, Conflict of Interest: None
Background: Tuberculosis (TB) is a global public health problem. Although curable, it is the most common cause of human immunodeficiency virus (HIV) related illness and death. Globally it was estimated that about 12 million people living with HIV/AIDS (PLHIV) are co-infected with tuberculosis (TB). The low immune system resulting from HIV confers the risk known for re-activation of latent or recent TB infection to active TB and increase the rate of recurrence of TB.
Materials and Methods: New patients registered with the DOTS clinic meeting TB case definition, diagnosed based on findings suggestive of pulmonary tuberculosis (PTB) on clinical and radiological examination (chest X-ray), and sputum testing for AFB (acid fast bacilli) were offered provider initiated HIV counseling and testing (PICT) using HIV Uni-Gold and Determine test kits.
Results: A total of 2, 456 of adult pulmonary tuberculosis (TB) patients were enrolled for 2 years (2007-2009). 462 (18.8%) out of 2,456 were HIV sero-positive. HIV prevalence is higher in female patients (15.9%) than male patients (10.5%) with a statistical difference (P < 0.05). HIV sero-prevalence also varied among the different age group. The peak age prevalence was in the age group 25-34 years accounting for 43.9% and the least with 1.5% in the group 65 and above years old.
Conclusion: Diagnosing HIV infection among patients with pulmonary tuberculosis (TB) should be an offortunity for referrals for measure of the prevention and treatment of common HIV related illness, ongoing provision of social and psychological support and anti-retroviral therapy.
Keywords: Directly observed treatment short, human immunodeficiency virus, Nigeria seroprevalence, tuberculosis
|How to cite this article:|
Yusuf M, Azeez-Akande O, Yusha置 M. HIV sero-prevalence among adult with newly diagnosed pulmonary tuberculosis in Kano, Nigeria. J Med Trop 2013;15:140-3
| Introduction|| |
Tuberculosis (TB) is a major public health problem in Nigeria with the country currently ranks 10 th among the 22 high-burden TB countries in the world. World Health Organization estimates that 210,000 new cases of all forms of TB occurred in the country in 2010, equivalent to 133/100,000 population. There were an estimated 320,000 prevalent cases of TB in 2010, equivalent to 199/100,000 cases.  Although Tuberculosis (TB) is curable, is the most common cause of HIV-related illness and death. It was estimated that about 12 million people living with HIV/AID (PLHIV) are co-infected with TB (70% in sub-Saharan African and 22% in South East Asia). Since mid-1980, annual TB case notification rates have risen up to four fold in many African countries, including those with well-organized programmes. 
Human immunodeficiency virus (HIV) infection is the leading risk factor for tuberculosis (TB). It promotes progression of latent or recent infections of Mycobacterium tuberculosis (MTB) to active diseases and also increases the rate of recurrence of TB. It may also increase the susceptibility to infection with MTB in HIV infected people. HIV-negative persons infected with MTB have a life time risk of TB ranging from 10% to 20%. However, in person co-infected with MTB and HIV the annual risk can exceed 10%. 
In Africa, the number of Tuberculosis (TB) cases has been on the rise over the last two decades, coinciding with the increase in adult HIV prevalence rate.  Although the prevalence of HIV infections varies widely between and within countries, among persons with HIV there is always an increased risk of TB. The difference in HIV prevalence means that a variable percentage of patients with TB will have HIV Infection as well.  Rates of HIV infection and TB are high and continue to increase in many nations in sub-Saharan Africa. 
The aim of this study was to determine the HIV sero-prevalence among adults with newly diagnosed pulmonary tuberculosis (PTB) registered at the chest clinic, Infectious Diseases Hospital, IDH, Kano, Nigeria.
| Materials and Methods|| |
A prospective study was carried out over a period of 2 years (July 2009- August 2011) at the Infectious Diseases Hospital, IDH, Kano State in North-Western Nigeria. The hospital has a TB diagnosis and treatment centers, HIV counseling and testing center, and Antiretroviral (ART) clinic. The hospital is the only infectious diseases hospital in the whole of Northern Nigeria and serves as a referral center for Tuberculosis (TB) and HIV/AIDS management which are provided to the patients at no cost. During the 24-month period of study patients with newly diagnosed pulmonary tuberculosis (PTB) that registered at the Directly Observed Treatment Short course chemotherapy (DOTS) clinic were used for the study. The eligible patients that met the inclusion criteria were identified through TB case register and selected. Inclusion criteria includes new TB patients with unknown HIV status, 15 years or more of age meeting TB case definition,
Diagnosed of pulmonary tuberculosis (PTB) based on clinical examination and whose initial sputum smears demonstrated acids fast bacilli (AFB) by direct smear sputum microscopy using Ziehl-Nelseen (ZN) stain at least two times in line with World Health Organization (WHO) recommendation, and radiological examination (Chest X-ray) finding suggestive of pulmonary tuberculosis (PTB). Patients on re-treatment regimen, children below 15 years of age, those diagnosed with extra pulmonary or with severe concomitant medical conditions and those with known HIV status were excluded from the study.
The patients were offered confidential HIV testing accompanied by pre and post test counseling according to the Nigerian National HIV/AIDS Program Guidelines after providing informed consent to participate in the study for ethical reason. Those that agreed to be tested had blood sample taken for HIV test and performed according to the standard hospital practice and followed guidelines developed by the Nigerian National HIV Algorithm for serial rapid testing.
All samples were first tested with Determine rapid test kits and if positive, were then tested with the Uni-Gold rapid test kits. Uni-Gold reactive samples were considered positive. Those who refused HIV testing after counseling were not included in the study.
A total of two thousand four hundred and fifty six (2, 456) new patients diagnosed with pulmonary tuberculosis (PTB) registered at the Directly Observed Treatment Short course chemotherapy (DOTS) clinic who accepted to be offered Confidential HIV counseling and testing were recruited into the study. Data for the study was collected from the medical files and other hospital records of the studied patients.
The Research and Ethics Committee of Kano State Hospital Management Board, Kano, approved the study.
| Results|| |
The demographic and socio economic characteristics of the patients are shown in [Table 1], [Table 2] and [Table 3]. Nine hundred (37%) of the patients age range between 25 and 34 years are the majority followed by 629 (26%) with a ranged of 35-44 years, while only twenty seven (1%) of the patients age ranged above 65 years. Based on the educational career majority of the studied patients 1,048 (43%) had no formal education, while the least 173 (7%) had education level up to higher institution. On the occupation of the patients, most of the patients, 996 (41%) were unemployed followed by house wives 637 (27%). Out of the 2,456 diagnosed with pulmonary tuberculosis (PTB) patients tested of whom 790 (32%) were sputum smear-positive and 1,666 (68%) sputum smear-negative as shown in [Table 4]. 462 were HIV positive with an overall HIV prevalence of 18.8%. HIV prevalence was also higher among females (15.9%) than male (10.5%) patients with a statistical difference (P < 0.05). However, the HIV infection varied among the different age group as shown in [Figure 1] with a prevalence of 43.9% in the age group 25-34 years as compared to only 1.5% in the age group 65 and above years which was statistically different (P < 0.05).
|Figure 1: Sero-prevalence of HIV among the studied patients by age group|
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| Discussion|| |
Various studies have been conducted on tuberculosis (TB) and HIV co-infection and reports vary. Based on the result of this study the overall prevalence of the HIV infection among the studied patients was found to be 18.8% [Table 5]. The 18.8% HIV sero-prevalence found among pulmonary tuberculosis (PTB) patients is markedly higher than in the study conducted in Maiduguri where the proportion HIV co-infection with positive TB was found to be 12.5%.  , in Jos whereby out of the 180 newly diagnosed pulmonary tuberculosis patients, 11 (6.1%) were confirmed seropositive for HIV-1 and 2.  , and in Sagamu where the study demonstrated a frequency of 14.9% of HIV sero-prevalence amongst TB population.  This finding is consistent with results reported in a national study on HIV prevalence in the Nigerian states that varied from 4.2% in Oyo to 35.1% in Benue States with a median prevalence of 17.0%. HIV prevalence increased with age to a peak of 23.9% among PTB patients 30-39 years and then declined progressively to 12.8% among those 60 years and above. 
|Table 5: The total number of HIV seropositive PTB patients by sex and age |
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The TB/HIV co-infection rate in our study is lower than the finding of the study where by 257 TB patients screened, 44.20% (106) were HIV positive. The prevalence of co-infection was higher among the female (44.82%) than the male (38.30%) patients and highest among those aged 21-40 years old (45.30%).  The finding of 18.8% HIV prevalence among TB patients is comparable to similar surveys conducted among TB patients. In sub-Saharan Africa, a study reported that 38% of new adult TB cases were infected with HIV.  This is also lower than finding of a study in Tanzania which showed that 32% of all the TB smears positive were co-infected with HIV.  Studies conducted in the Kalongo District of Malawi showed that proportion of smear-positive tuberculosis (TB) cases co-infected with HIV increased from 17% in 1988 to 1990 to 57% in 2000 -2001. 
In many countries of the world the link between HIV and TB is often well known, but few TB patients currently have the opportunity to know the new HIV status. The stigma attached to HIV may deter people with features of suspicious of TB from seeking TB care.  National HIV programmes could dramatically diminish the extent to which despite the occasional reluctance of health workers to talk to TB patients about HIV, diagnosing HIV infection should be an opportunity for referral for ongoing provision of social and psychological support, for measures for the prevention and treatment of common HIV - related illnesses, and anti-retroviral therapy (ART). It is more common for patients to find out that they are HIV-positive after developing TB than to already know that they are HIV-positive and then later on develop TB. In either case, The National Tuberculosis programmes need to coordinate closely with other services providing support and care for HIV-positive individuals. Clinicians treating HIV-infected TB patients are in a key position to refer patients to, or to provide them with, appropriate services for counseling, support, and care of patients and their families. National Tuberculosis and HIV programmes should collaborate closely with general healthcare providers to improve the quality and continuity of care of HIV-infected TB patients.
One of the main strength of this study is that the HIV prevalence data in the studies of TB patients can served as an indicator of the degree of spread of HIV infection into the general population, and the it will be used for planning the provision of comprehensive HIV/AIDS care and support in the community.
This study had some weaknesses. First, the diagnosis of smear positive pulmonary tuberculosis (PTB) is based on microscopy as no culture was done for confirmation. Second, HIV-positive cases were not confirmed by Western blot method (Test kit made by Genelabs Technologies Inc., Singapore) after testing positive for a HIV antibody using two different types of enzyme-linked immunosorbent assays (ELISA)
| Conclusion|| |
The established high human immunodeficiency virus prevalence among the studied patients with adult pulmonary tuberculosis showed that co-infection is still a problem and the need for provider initiated HIV counseling and testing for all TB patients, enrollment in to HIV care for those found to be infected, CD4 count testing, provision of cotrimoxaxole preventive therapy (CPT) and anti-retroviral therapy (ART).
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[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]