Mycobacterium tuberculosis Infections in HIV-infected Patients

Bilek, Heval Can; TANYEL, ESRA; Deveci, Aydın

doi:10.5578/flora.20219910

Mycobacterium tuberculosis Infections in HIV-infected Patients

Heval Can BİLEK, (Ondokuz Mayıs Üniversitesi, Tıp Fakültesi Hastanesi, İnfeksiyon Hastalıkları ve Klinik Mikrobiyoloji Anabilim Dalı, Samsun, Türkiye)

Aydın DEVECİ, (Ondokuz Mayıs Üniversitesi, Tıp Fakültesi Hastanesi, İnfeksiyon Hastalıkları ve Klinik Mikrobiyoloji Anabilim Dalı, Samsun, Türkiye)

Esra TANYEL (Ondokuz Mayıs Üniversitesi, Tıp Fakültesi Hastanesi, İnfeksiyon Hastalıkları ve Klinik Mikrobiyoloji Anabilim Dalı, Samsun, Türkiye)

Flora İnfeksiyon Hastalıkları ve Klinik Mikrobiyoloji Dergisi

0 0

Yıl: 2021 Cilt: 26 Sayı: 1 Sayfa Aralığı: 104 - 110 Metin Dili: İngilizce DOI: 10.5578/flora.20219910 İndeks Tarihi: 21-05-2021

Mycobacterium tuberculosis Infections in HIV-infected Patients

Öz:

Introduction: Tuberculosis (TB) still continues to be the leading cause of death for Human Immunodeficiency Virus (HIV) infected patients, and it accounts for approximately one of three acquired immunodeficiency syndrome (AIDS) related deaths. The study aimed to analyze clinical and laboratory data of Mycobacterium tuberculosis infection in HIV infected patients. Materials and Methods: Medical records of adult (aged≥ 18 years) HIV infected patients diagnosed and under medical care between January 2005 and November 2018 were obtained and analyzed retrospectively by searching hospital database system.Results: Fifteen patients (4.5%) had TB among the 336 HIV infected patients. There was no statistically significant difference between the age of HIV-infected patients with and without TB disease (38.07 ± 8.48 vs 39.26 ± 11.67; p: 0.697). Diagnosis of TB disease and HIV infection were concurrent during presentation in 9 (60%) patients, while six (40%) patients had a previous history of HIV infection and treatment. Five (83.3%) of 6 patients receiving antiretroviral therapy (ART) had no viral suppression due to non-adherence. Median CD4 T lymphocyte count was 114/mm3 (0-436) at the time of TB diagnosis whereas it was 408/mm3 (1-1734) in those without TB disease at the time of initial HIV infection diagnosis, and the difference was statistically significant (p< 0.05). Odds ratio for CD4 T lymphocyte count less than 200 in HIV infected patients with TB disease was 14.89 (confidence interval 95%: 4.08-54.34). While ten (66.7%) patients had pulmonary involvement, five (33.3%) patients had extrapulmonary involvement. There was no statistically significant difference between the median CD4 T lymphocyte counts of patients with pulmonary involvement (107/mm3, range:0-436) and extrapulmonary involvement (140/mm3, range: 86-259) (p= 0.391). Conclusion: Tuberculosis disease should be considered in patients who have applied at advanced stages of HIV infection or whose virological suppression could not be achieved due to incompatibility with ART treatment.

Anahtar Kelime:

HIV ile İnfekte Hastalarda Mycobacterium tuberculosis İnfeksiyonları

Öz:

Giriş: Tüberküloz (TB), İnsan immün yetmezlik virüsü (Human immunodeficiency virus: HIV) ile infekte hastalarda önde gelen ölüm nedeni olmaya devam etmekte olup, kazanılmış immün yetmezlik sendromu (Acquired immunodeficiency syndrome: AIDS) ile ilgili her üç ölümden yaklaşık birinin nedenini oluşturmaktadır. Bu çalışmada HIV ile infekte hastalarda gelişen TB hastalığının klinik ve labora-tuvar verilerinin irdelenmesi amaçlandı. Materyal ve Metod: Ocak 2005 ve Kasım 2018 tarihleri arasında HIV tanı ve tedavisi alan 18 yaş ve üzerindeki hastalar çalışmaya dahil edildi. Hastaların verileri hastane otomasyon kayıt sistemi taranarak retrospektif olarak elde edildi. Bulgular: Çalışma döneminde 336 HIV ile infekte hasta tespit edildi. Hastaların 15'inde (%4.5) TB hastalığı saptandı. TB hastalığı olan ve olmayan HIV ile infekte hastaların yaş ortalaması (38.07 ± 8.48 vs 39.26 ± 11.67) arasında istatiksel olarak anlamlı bir fark yoktu (p:0.697). TB hastalığı tanısı, dokuz (%60) hastada HIV infeksiyonu tanısı aldığı anda konulurken, altı (%40) hastada ise daha önceden HIV infeksiyonu ve tedavisi öyküsü vardı. Antiretroviral tedavi (ART) deneyimli olan beş hastada tedavi uyumsuzluğu nedeniyle viral baskılanma sağlanmamıştı. TB hastalığı olan HIV ile infekte hastalarda TB tanısı sırasında ortanca CD4 T lenfosit sayısı 108/mm3 (0-436); TB hastalığı olmayanlarda HIV infeksiyonunun tanısı sırasında ise 408/mm3 (1-1734) olarak belirlendi ve aradaki fark istatistiksel açıdan anlamlıydı (p< 0.05). TB hastalığı olan HIV ile infekte hastalarda CD4 T lenfosit sayısının 200/mm3‘ün altında olma Odds oranı 14.89‘du (%95 güven aralığı: 4.08-54,34). Hastaların onunda (%66.7) akciğer tutulumu mevcutken beş (%33.3) hastada ise ekstrapulmoner tutulum mevcuttu. Akciğer tutulumu olan hastalar medyan CD4 T lenfosit sayısı 107/mm3 (0-436) iken ekstrapul-moner tutulumu olan hastalarda ise 140/mm3‘tü (86-259) ve her iki grup arasında istatiksel açıdan anlamlı bir fark yoktu (p= 0.391).Sonuç: HIV infeksiyonunun ilerlemiş evrelerinde başvuran veya ART tedavisine uyumsuzluk nedeni ile virolojik baskılanma sağlanama-mış hastalarda tüberküloz hastalığı göz önünde bulundurulmalıdır.

Anahtar Kelime:

Belge Türü: Makale Makale Türü: Araştırma Makalesi Erişim Türü: Erişime Açık

1. UNAIDS. Global HIV & AIDS statistics-2019 fact sheet. HIV/tuberculosis (TB). Available from: https://www.unaids. org/en/resources/fact-sheetfact-sheet. Accessed date: 02.11.2019.
2. Getahun H, Gunneberg C, Granich R, Nunn P. HIV infection- associated tuberculosis: the epidemiology and the response. Clin Infect Dis 2010;50(3):201-S207.
3. Selwyn PA, Hartel D, Lewis VA, Schoenbaum EE, Vermund SH, Robert S, et al. A prospective study of the risk of tuberculosis among intravenous drug users with human immunodeficiency virus infection. N Engl J Med 1989;320:545- 50.
4. Whalen C, Horsburgh CR, Hom D, Lahart C, Simberkoff M, Ellner J. Accelerated course of human immunodeficiency virus infection after tuberculosis. Am J Respir Crit Care Med 1995;151:129-35.
5. Modjarrad K, Vermund SH. Effect of treating co-infections on HIV-1 viral load: a systematic review. Lancet Infect Dis 2010;10:455-63.
6. Dye C, Scheele S, Dolin P, Pathania V, Raviglione MC. Consensus statement. Global burden of tuberculosis: estimated incidence, prevalence, and mortality by country. WHO Global Surveillance and Monitoring Project. JAMA 1999;282:677-86.
7. Lillebaek T, Dirksen A, Vynnycky E, Baess I, Thomsen VO, Andersen AB, et al. Stability of DNA patterns and evidence of Mycobacterium tuberculosis reactivation occurring decades after the initial infection. J Infect Dis 2003;188:1032-9.
8. Aaron L, Saadoun D, Calatroni I, Launay O, Memain N, Andersen AB. Tuberculosis in HIV-infected patients: a comprehensive review. Clin Microbiol Infect 2004; 10: 388–98.
9. Gao J, Zheng P, Fu H. Prevalence of TB/HIV co-infection in countries except China: a systematic review and meta-analysis. PLoS One 2013;8(5):e64915.
10. World Health Organization (WHO). Global tuberculosis report 2019. Available from: https://apps.who.int/iris/ bitstream/handle/10665/329368/9789241565714-eng. pdf?ua=1. Accessed date: 02.11.2019.
11. Gümüşer F, Altınkaynak M, Yıldız Sevgi D, Altuntaş Aydın Ö, Mete B, Gündüz A, et al. Human immunodeficiency virus and tuberculosis coinfection: clinical features and predictors of mortality. Turk J Med Sci 2018;14;48(3):503-8.
12. Patel NR, Zhu J, Tachado SD, Zhang J, Wan Z, Saukkonen JJ, et al. HIV impairs TNF-alpha mediated macrophage apoptotic response to Mycobacterium tuberculosis. J Immunol 2007;179:6973-80.
13. Jones BE, Young SM, Antoniskis D, Davidson PT, Kramer F, Barnes PF. Relationship of the manifestations of tuberculosis to CD4 cell counts in patients with human immunodeficiency virus infection. Am Rev Respir Dis 1993;148:1292-7.
14. Naing C, Mak JW, Maung M, Wong SF, Kassim AI. Meta-analysis: the association between HIV infection and extrapulmonary tuberculosis. Lung 2013;191:27-34.
15. Hopewell P, Pai M, Maher D, Uplekar M, Raviglione MC. International standards for tuberculosis care. Lancet Infect Dis 2006;6:710-25.
16. Sonnenberg P, Glynn JR, Fielding K, Murray J, Godfrey-Faussett P, Shearer S. How soon after infection with HIV does the risk of tuberculosis start to increase? A retrospective cohort study in South African gold miners. J Infect Dis 2007;191:150-8.
17. Cattamanchi A, Dowdy DW, Davis JL, Worodria W, Yoo S, Joloba M, et al. Sensitivity of direct versus concentrated sputum smear microscopy in HIV-infected patients suspected of having pulmonary tuberculosis. BMC Infect Dis 2009;9:53.
18. World Health Organization (WHO). Improving the diagnosis and treatment of smear-negative pulmonary and extrapulmonary tuberculosis among adults and adolescents: recommendations for HIV-prevalent and resource-constrained settings. Available from: https://apps.who.int/iris/bitstream/ handle/10665/69463/WHO_HTM_TB_2007.379_ eng.pdf;jsessionid=ECA6CD5A1A3D06B99871287F80EB0AD9? sequence=1. Accessed date: 02.11.2019.
19. Centers for Disease Control and Prevention. Updated guidelines for the use of nucleic acid amplification tests in the diagnosis of tuberculosis. MMWR Morb Mortal Wkly Rep 2009;58:7-10.
20. Kambashi B, Mbulo G, McNerney R, Tembwe R, Kambashi A, Tihon V, et al. Utility of nucleic acid amplification techniques for the diagnosis of pulmonary tuberculosis in Sub-Saharan Africa. Int J Tuberc Lung Dis 2001;5:364-9.
21. Piersimoni C, Scarparo C. Relevance of commercial amplification methods for direct detection of Mycobacterium tuberculosis complex in clinical samples. J Clin Microbiol 2003;41:5355-65.
22. Greenberg SD, Frager D, Suster B, Walker S, Stavropoulos C, Rothpearl A. Active pulmonary tuberculosis in patients with AIDS: spectrum of radiographic findings (including a normal appearance). Radiology 1994;193:115-9.
23. Leung AN. Pulmonary tuberculosis: the essentials. Radiology 1999;210:307-22.
24. Centers for Diseases Control and Prevention. Guidelines for the investigation of contacts of persons with infectious tuberculosis; recommendations from the national Tuberculosis Controllers Association and CDC, and Guidelines for using QuantiFERON®-TB Gold test for detecting Mycobacterium tuberculosis infection. United States. MMWR 2005;54:1-55.
25. Orenstein EW, Basu S, Shah NS, Andrews JR, Friedland GH, Moll AP, et al. Treatment outcomes among patients with multidrug-resistant tuberculosis: systematic review and meta- analysis. Lancet Infect Dis 2009;9:153-61.

APA	Bilek H, Deveci A, TANYEL E (2021). Mycobacterium tuberculosis Infections in HIV-infected Patients. , 104 - 110. 10.5578/flora.20219910
Chicago	Bilek Heval Can,Deveci Aydın,TANYEL ESRA Mycobacterium tuberculosis Infections in HIV-infected Patients. (2021): 104 - 110. 10.5578/flora.20219910
MLA	Bilek Heval Can,Deveci Aydın,TANYEL ESRA Mycobacterium tuberculosis Infections in HIV-infected Patients. , 2021, ss.104 - 110. 10.5578/flora.20219910
AMA	Bilek H,Deveci A,TANYEL E Mycobacterium tuberculosis Infections in HIV-infected Patients. . 2021; 104 - 110. 10.5578/flora.20219910
Vancouver	Bilek H,Deveci A,TANYEL E Mycobacterium tuberculosis Infections in HIV-infected Patients. . 2021; 104 - 110. 10.5578/flora.20219910
IEEE	Bilek H,Deveci A,TANYEL E "Mycobacterium tuberculosis Infections in HIV-infected Patients." , ss.104 - 110, 2021. 10.5578/flora.20219910
ISNAD	Bilek, Heval Can vd. "Mycobacterium tuberculosis Infections in HIV-infected Patients". (2021), 104-110. https://doi.org/10.5578/flora.20219910

APA	Bilek H, Deveci A, TANYEL E (2021). Mycobacterium tuberculosis Infections in HIV-infected Patients. Flora İnfeksiyon Hastalıkları ve Klinik Mikrobiyoloji Dergisi, 26(1), 104 - 110. 10.5578/flora.20219910
Chicago	Bilek Heval Can,Deveci Aydın,TANYEL ESRA Mycobacterium tuberculosis Infections in HIV-infected Patients. Flora İnfeksiyon Hastalıkları ve Klinik Mikrobiyoloji Dergisi 26, no.1 (2021): 104 - 110. 10.5578/flora.20219910
MLA	Bilek Heval Can,Deveci Aydın,TANYEL ESRA Mycobacterium tuberculosis Infections in HIV-infected Patients. Flora İnfeksiyon Hastalıkları ve Klinik Mikrobiyoloji Dergisi, vol.26, no.1, 2021, ss.104 - 110. 10.5578/flora.20219910
AMA	Bilek H,Deveci A,TANYEL E Mycobacterium tuberculosis Infections in HIV-infected Patients. Flora İnfeksiyon Hastalıkları ve Klinik Mikrobiyoloji Dergisi. 2021; 26(1): 104 - 110. 10.5578/flora.20219910
Vancouver	Bilek H,Deveci A,TANYEL E Mycobacterium tuberculosis Infections in HIV-infected Patients. Flora İnfeksiyon Hastalıkları ve Klinik Mikrobiyoloji Dergisi. 2021; 26(1): 104 - 110. 10.5578/flora.20219910
IEEE	Bilek H,Deveci A,TANYEL E "Mycobacterium tuberculosis Infections in HIV-infected Patients." Flora İnfeksiyon Hastalıkları ve Klinik Mikrobiyoloji Dergisi, 26, ss.104 - 110, 2021. 10.5578/flora.20219910
ISNAD	Bilek, Heval Can vd. "Mycobacterium tuberculosis Infections in HIV-infected Patients". Flora İnfeksiyon Hastalıkları ve Klinik Mikrobiyoloji Dergisi 26/1 (2021), 104-110. https://doi.org/10.5578/flora.20219910