Manuela Arbune 1, Otilia Benea 2, C. Scorpan 3
1 Infectious Diseases Hospital, Galaţi, Romania
2 “Matei Balş” National Institute of Infectious Diseases, Bucharest, Romania
3 Pneumophtisiology Hospital, Galaţi
Abstract
HIV screening of tuberculosis patients has been a common practice in Romania, since1998. Compared to the national statistics, the Galaţi county has similar prevalence of HIV/AIDS but higher prevalence of TB. The study is a retrospective analytic study assessing the epidemiology and clinical characteristics of HIV tuberculosis coinfection in Galaţi during 1998-2008. A number of 98 cases of HIV/TB were recorded out of the total 324 HIV cases. The average annual incidence of tuberculosis was over 30 times higher in HIV positive patients (5.2%) than in HIV negative ones and it displayed a tendency of increasing. HIV was acquired vertically (11%), sexually (19%) or horizontally during early childhood (70%). 44% of the patients had tuberculosis as the primary AIDS defining event, while 26.5% developed tuberculosis after HIV diagnosis. 45% of the cases had extra-pulmonary tuberculosis involvement and correlated with lower CD4 count, older age and mortality rate. 50% had microbiological criteria for tuberculosis diagnosis. The rate of microbiological evidence was lower in the primary pulmonary tuberculosis than in the secondary one and correlated with younger age. 27% of the patients received antiretroviral treatment (ARV) at the time of tuberculosis diagnosis and 2 developed tuberculosis as immune reconstruction event. Out of 98 HIV/ tuberculosis patients, 67 were cured, 11 relapsed and 21 died. The risk of death is related to the severity of the immunosuppression at the time of tuberculosis diagnosis (median CD4 count of 219 in survivors vs. 42 in the case of deceased patients, p< 0.001). The risk factors for death in HIV/ tuberculosis co-infection are low CD4, extra-pulmonary involvement and older age. A new strategy for the improvement of tuberculosis diagnosis in HIV patients should allow earlier medical involvement in order to decrease the HIV- tuberculosis mortality in Galaţi – Romania. Keywords: HIV, tuberculosis, prevalence, diagnosis, death.