title: Factors Associated with Prevalent Tuberculosis Among Patients Receiving Highly Active Antiretroviral Therapy in a Nigerian Tertiary Hospital.
abstract: BACKGROUND
  Tuberculosis (TB) causes significant morbidity/mortality among human immunodeficiency virus-infected individuals in Africa. Reducing TB burden in the era of highly active antiretroviral therapy (HAART) is a public health priority.
  
  
  OBJECTIVE
  We determined the factors associated with prevalent TB among patients receiving HAART.
  
  
  METHODS
  We conducted a cross-sectional study of adult patients who had received HAART for ≥12 weeks in a Nigerian tertiary hospital. Patients whose TB diagnosis predated HAART were excluded from the study. Pre-HAART data were collected from the clinic records, whereas post-HAART data were obtained through medical history, physical examination, and laboratory investigations. Standard TB screening/diagnostic algorithms as applicable in Nigeria were used. Logistic regression analysis was used to determine factors independently associated with prevalent TB.
  
  
  RESULTS
  about 65.8% (222/339) were women. The mean age was 41.1 (10.0) years and 23.6% (73/339) had past history of TB. The prevalence of active TB was 7.7% (26/339). Among these patients, 42.3% (11/26) had pulmonary TB, 34.6% (9/26) had disseminated TB, whereas 23.1% (6/26) had only extra-pulmonary disease. Only 45% (9/20) of patients with pulmonary involvement had positive sputum smear. Factors independently associated with prevalent TB were lower social class (adjusted odds ratio [aOR]: 31.7; 95% confidence interval [CI]: 1.1-1417.3), HAART non-adherence (aOR125.5; 95% CI: 9.6-1636.3), baseline CD4 <200cells/μl (aOR31.0; 95%CI: 1.6-590.6), previous TB (aOR13.8; 95% CI: 2.0-94.1), and current hemoglobin <10 g/dl (aOR10.3; 95% CI: 1.1-99.2).
  
  
  CONCLUSIONS
  Factors associated with prevalent TB were a lower social class, HAART non-adherence, severe immunosuppression before HAART initiation, previous TB, and anemia post-HAART. TB case finding should be intensified in these high-risk groups.
authors.affiliation: Infectious Diseases Unit, Department of Medicine, College of Medicine, University of Nigeria, Enugu Campus, Enugu State, Nigeria; Department of Internal Medicine, Federal Medical Centre, Owerri, Imo State, Nigeria; Faculty of Community and Health Sciences, School of Public Health, University of the Western Cape, South Africa.
authors.forename: M O
authors.initials: MO
authors.lastname: Iroezindu
authors.affiliation: Department of Internal Medicine, Federal Medical Centre, Owerri, Imo State, Nigeria.
authors.forename: E O
authors.initials: EO
authors.lastname: Ofondu
authors.affiliation: Department of Internal Medicine, Federal Medical Centre, Owerri, Imo State, Nigeria.
authors.forename: G C
authors.initials: GC
authors.lastname: Mbata
authors.affiliation: Faculty of Community and Health Sciences, School of Public Health, University of the Western Cape, South Africa.
authors.forename: B
authors.initials: B
authors.lastname: van Wyk
authors.affiliation: Faculty of Community and Health Sciences, School of Public Health, University of the Western Cape, South Africa; TB/HIV Care Association, Cape Town, South Africa.
authors.forename: H P
authors.initials: HP
authors.lastname: Hausler
authors.affiliation: Division of Pulmonary and Critical Care Medicine, University of Washington, Seattle, USA.
authors.forename: Au
authors.initials: A
authors.lastname: Dh
authors.affiliation: Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium.
authors.forename: L
authors.initials: L
authors.lastname: Lynen
authors.affiliation: Department of Medicine, Division of Pulmonary and Critical Care Medicine, San Francisco General Hospital, University of California, San Francisco, USA.
authors.forename: P C
authors.initials: PC
authors.lastname: Hopewell
keywords: Factors; Highly active antiretroviral therapy; Human immunodeficiency virus; Prevalent; Tuberculosis