Tuberc Respir Dis.  2015 Jul;78(3):253-257. 10.4046/trd.2015.78.3.253.

First Outcome of MDR-TB among Co-Infected HIV/TB Patients from South-West Iran

• Motamedifar M
• Ebrahim-Saraie HS
• Abadi AR
• Moghadam M

• KMID: 2320651
• DOI: http://doi.org/10.4046/trd.2015.78.3.253

Abstract

BACKGROUND
Tuberculosis (TB) is the leading cause of mortality among human immunodeficiency virus (HIV) patients and the majority of them occur in developing countries. The aims of the present study were to determine the frequency of HIV/TB co-infection and other probable associated factors.
METHODS
This 10 year retrospective study was conducted on 824 HIV patients in the south-west of Iran. HIV infection was diagnosed by the enzyme linked immunosorbent assay and confirmed by Western blot. TB diagnosis was based on consistency of the clinical manifestations, chest X-ray, and microscopic examination. Drug susceptibility testing was done by the proportional method on Lowenstein-Jensen media.
RESULTS
Of 824 HIV patients, 59 (7.2%) were identified as TB co-infected and the majority (86.4%) of them were male. Of the overall TB infected patients, 6 cases (10.2%) showed multidrug-resistant with the mean CD4+ lymphocyte count of 163+/-166 cells/mm3. The main clinical forms of TB were pulmonary (73%). There was a significant (p<0.05) correlation between TB infection and CD4+ lymphocyte counts < or =200 cells/mm3, gender, prison history, addiction history, and highly active anti-retroviral therapy.
CONCLUSION
We reported novel information on frequency of HIV/TB co-infection and multidrug resistant-TB outcome among co-infected patients that could facilitate better management of such infections on a global scale.

Keyword

Tuberculosis; Human Immunodeficiency Virus; Tuberculosis, Multidrug-Resistant; Iran

MeSH Terms

Blotting, Western
Coinfection
Developing Countries
Diagnosis
Enzyme-Linked Immunosorbent Assay
HIV
HIV Infections
Humans
Iran*
Lymphocyte Count
Male
Methods
Mortality
Prisons
Retrospective Studies
Thorax
Tuberculosis
Tuberculosis, Multidrug-Resistant

Figure

• 

  Figure 1 The distribution pattern of CD4+ lymphocyte count between human immunodeficiency virus (HIV) infected and HIV/tuberculosis (TB) co-infected patients.

Reference

1. Smith I. Mycobacterium tuberculosis pathogenesis and molecular determinants of virulence. Clin Microbiol Rev. 2003; 16:463–496.

2. Escombe AR, Moore DA, Gilman RH, Pan W, Navincopa M, Ticona E, et al. The infectiousness of tuberculosis patients coinfected with HIV. PLoS Med. 2008; 5:e188.

3. Pawlowski A, Jansson M, Skold M, Rottenberg ME, Kallenius G. Tuberculosis and HIV co-infection. PLoS Pathog. 2012; 8:e1002464.

4. 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:e64915.

5. Zadeh AO, SeyedAlinaghi S, Hassanzad FF, Hajizadeh M, Mohamadi S, Emamzadeh-Fard S, et al. Prevalence of HIV infection and the correlates among homeless in Tehran, Iran. Asian Pac J Trop Biomed. 2014; 4:65–68.

6. Venturini E, Turkova A, Chiappini E, Galli L, de Martino M, Thorne C. Tuberculosis and HIV co-infection in children. BMC Infect Dis. 2014; 14:Suppl 1. S5.

7. Varahram M, Nasiri MJ, Farnia P, Mozafari M, Velayati AA. A retrospective analysis of isoniazid-monoresistant tuberculosis: among Iranian pulmonary tuberculosis patients. Open Microbiol J. 2013; 8:1–5.

8. Rafiee S, Besharat S, Jabbari A, Golalipour F, Nasermoaadeli A. Epidemiology of tuberculosis in northeast of Iran: a population-based study. Iran J Med Sci. 2009; 34:193–197.

9. Masjedi MR, Tabarsi P, Chitsaz E, Baghaei P, Mirsaeidi M, Amiri MV, et al. Outcome of treatment of MDR-TB patients with standardised regimens, Iran, 2002-2006. Int J Tuberc Lung Dis. 2008; 12:750–755.

10. Masjedi MR, Farnia P, Sorooch S, Pooramiri MV, Mansoori SD, Zarifi AZ, et al. Extensively drug-resistant tuberculosis: 2 years of surveillance in Iran. Clin Infect Dis. 2006; 43:841–847.

11. Swaminathan S, Padmapriyadarsini C, Narendran G. HIV-associated tuberculosis: clinical update. Clin Infect Dis. 2010; 50:1377–1386.

12. Kwan CK, Ernst JD. HIV and tuberculosis: a deadly human syndemic. Clin Microbiol Rev. 2011; 24:351–376.

13. Farazi A, Sofian M, Zarrinfar N, Katebi F, Hoseini SD, Keshavarz R. Drug resistance pattern and associated risk factors of tuberculosis patients in the central province of Iran. Caspian J Intern Med. 2013; 4:785–789.

14. Wondimeneh Y, Muluye D, Belyhun Y. Prevalence of pulmonary tuberculosis and immunological profile of HIV co-infected patients in Northwest Ethiopia. BMC Res Notes. 2012; 5:331.

15. Rabirad N, Mohammad Nejad E, Hadizadeh MR, Begjan J, Ehsani SR. The Prevalence of Tb in HIV Patients and Risk Factor With Frequent Referral (Iran, 2009-10). Iran Red Crescent Med J. 2013; 15:58–61.

16. Lazarus JV, Olsen M, Ditiu L, Matic S. Tuberculosis-HIV coinfection: policy and epidemiology in 25 countries in the WHO European region. HIV Med. 2008; 9:406–414.

17. Khue PM, Phuc TQ, Hung NV, Jarlier V, Robert J. Drug resistance and HIV co-infection among pulmonary tuberculosis patients in Haiphong City, Vietnam. Int J Tuberc Lung Dis. 2008; 12:763–768.

18. Chaychuk TA, Gankina NU, Nikonova OG. Epidemiology of HIV-associated tuberculosis (TB) co-infection in Krasnoyarsk region, Russian Federation. J Int AIDS Soc. 2010; 13:Suppl 4. P193.

19. Olaniran O, Hassan-Olajokun RE, Oyovwevotu MA, Agunlejika RA. Prevalence of tuberculosis among HIV/AIDS patients in Obafemi Awolowo University Teaching Hospital Complex Oauthc, ILE-IFE. Int J Biol Med Res. 2011; 2:874–877.

20. Tabarsi P, Mirsaeidi SM, Amiri M, Mansouri SD, Masjedi MR, Velayati AA. Clinical and laboratory profile of patients with tuberculosis/HIV coinfection at a national referral centre: a case series. East Mediterr Health J. 2008; 14:283–291.

21. Santos Mde L, Ponce MA, Vendramini SH, Villa TC, Santos NS, Wysocki AD, et al. The epidemiological dimension of TB/sHIV co-infection. Rev Lat Am Enfermagem. 2009; 17:683–688.

22. Carvalho BM, Monteiro AJ, Pires Neto Rda J, Grangeiro TB, Frota CC. Factors related to HIV/tuberculosis coinfection in a Brazilian reference hospital. Braz J Infect Dis. 2008; 12:281–286.

23. Young BN, Rendon A, Rosas-Taraco A, Baker J, Healy M, Gross JM, et al. The effects of socioeconomic status, clinical factors, and genetic ancestry on pulmonary tuberculosis disease in northeastern Mexico. PLoS One. 2014; 9:e94303.

24. Hargreaves JR, Boccia D, Evans CA, Adato M, Petticrew M, Porter JD. The social determinants of tuberculosis: from evidence to action. Am J Public Health. 2011; 101:654–662.

25. Deribew A, Tesfaye M, Hailmichael Y, Negussu N, Daba S, Wogi A, et al. Tuberculosis and HIV co-infection: its impact on quality of life. Health Qual Life Outcomes. 2009; 7:105.

26. Kantipong P, Murakami K, Moolphate S, Aung MN, Yamada N. Causes of mortality among tuberculosis and HIV co-infected patients in Chiang Rai, Northern Thailand. HIV AIDS (Auckl). 2012; 4:159–168.

27. Lee CH, Hwang JY, Oh DK, Kee MK, Oh E, An JW, et al. The burden and characteristics of tuberculosis/human immunodeficiency virus (TB/HIV) in South Korea: a study from a population database and a survey. BMC Infect Dis. 2010; 10:66.

28. Swaminathan S, Nagendran G. HIV and tuberculosis in India. J Biosci. 2008; 33:527–537.

29. Akinbami AA, Adegboyega AO, Oshinaike OO, Adebola PA, Enabulele C, Dosunmu OA, et al. Chest X-ray findings in HIV patients in relation to the CD4 count. Nig Q J Hosp Med. 2011; 21:306–311.