title: Tuberculosis-HIV co-infection among patients admitted at Muhimbili National Hospital in Dar es salaam, Tanzania.
abstract: Data on the clinical presentations and magnitude of tuberculosis (TB)-human immunodeficiency virus (HIV) co-infection is limited. The objective of this study was to describe the clinical presentation and prevalence of TB-HIV co-infection among patients admitted at Muhimbili National Hospital between August 2008 and July 2009 in Dar es Salaam, Tanzania. Of 387 TB patients included, 117 (30.2%) were in the age group 30-39 years. The overall mean age of patients was 38.1 years (range 8 to 86 years) and 216 (55.8%) were male. Two hundred and five (53%) had pulmonary tuberculosis (PTB), 58 (15%) had extra pulmonary tuberculosis (EPTB) and 124 (32%) had both PTB and EPTB. Common sites of EPTB were pleural cavity 80 (44%), lymph node 31 (17%) and 30 (16.5%) abdomen. Of the 300 TB patients tested for HIV, 175 (58.3%) were HIV-infected and 97 (55.4%) of these were already on antiretroviral therapy (ART) at time of admission. Overall, 104 (26.9%) of the TB patients admitted died. About two thirds of patients who died had PTB. About three quarters (73.1%; N=283) of the patients were discharged home to continue with anti-TB treatment. There was significantly higher proportion of deaths among HIV-infected TB patients (29.1% versus 15.2%) than in the HIV uninfected TB patients (P=0.005). Age was a significant predictor for PTB (OR 0.946, 95% CI 0.917-0.976) while age (OR 1.019, 95% CI 1.002-1.036) and HIV serostatus (OR 2.143, 95% CI 1.313-3.497) were significant risk factors for EPTB. It is concluded that more than half of the patients had PTB and pleural cavity was the most common site of EPTB. TB-HIV co-infected patients had significantly higher mortality than the TB-HIV- uninfected patients. It is recommended to emphasize on the provision of HIV counselling and testing to all TB patients to ensure proper management and timely initiation of ART in TB-HIV co-infected patients in order to improve the outcome and reduce mortality.
authors.affiliation: School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
authors.forename: Pili
authors.initials: P
authors.lastname: Kamenju
authors.affiliation: Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar es Salaam, Tanzania.
authors.forename: Said
authors.initials: S
authors.lastname: Aboud
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D044966:Anti-Retroviral Agents / Q000627:therapeutic use; D002648:Child; D060085:Coinfection / Q000097:blood / Q000453:epidemiology*; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000097:blood / Q000188:drug therapy / Q000453:epidemiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D017678:Sex Distribution; D013636:Tanzania / Q000453:epidemiology; D014376:Tuberculosis / Q000453:epidemiology* / Q000473:pathology; D055815:Young Adult
chemical_list: D044966:Anti-Retroviral Agents