Background & Objectives: Globally patients living with HIV (PLHIV) are more prone to develop active TB disease than those living without HIV due to immunosuppression and reactivation. Also the fact that MDR-TB & XDR-TB are more common among HIV-TB co-infection cases.  WHO suggests the use of Gene-Xpert to diagnose HIV-TB and the RIF resistance.  PTB is reported in 75% of cases of HIV-TB.  The objective is to study the burden of seroprevalence of HIV-TB co-infection among the population of Visakhapatnam in Andhra Pradesh. 

Material & Methods:  The case finding data is collected from the ART center of District Tuberculous Center of Visakhapatnam, AP with permission and clearance.  A total of 22,504 cases of tuberculosis and 1577 cases of HIV out of it for the period 2015 to 2018 is tabulated and analysed on excel sheet with SPSS software to study the HIV rate among TB cases. The present study deals with 361 cases of confirmed TB (Table-5) out of presumptive TB cases of tested 4704 of  the total screened 69,566  cases of HIV-TB. It is retrospective, study conducted at the research center, GIMSR (Gitam Institute of Medical Sciences & Research) Visakhapatnam, AP.

Results: The prevalence is 0.52% which is just higher than the National average prevalence of 0.26%.  And average prevalence rate of HIV-TB per one lakh population is 3.89(Table-7) of total population of Visakhapatnam Urban in AP State.

Conclusions:  The confirmed HIV-TB cases range from 6.64% to 7.87% out of the presumptive TB cases among the screened cases at ART-OP. Raising the immune status of the patient by improving nutrition, correcting anaemia with blood transfusion.  HIV-TB Co-Infection has to be regarded as a special area of public health problem by linking RNTCP with NACP.

Keywords:  Co-Infection, TB- HIV, Prevalence, Retrospective, study.

1. Diwakar Tumkur Narasimhamurthy, David Mathew Thomas - Clinical profile and outcome of HIV-TB Co-Infection at a centre of excellence for HIV care – Asian J. of Med. Sci. - Mar-Apr 2018 Vol - 9, Issue – 2.
2. Prashant D. Warkari, Mahavir P. Nakel – Study of treatment outcome of tuberculosis among HIV co-infected patients : a cross section study in Aurangabad city, Maharashtra – Int. J. Of Comm. Med. & Pub. Health – Dec 2017, Vol-4, Issue 12.
3. Matilda Gjergji, Jul Bushati - Tuberculosis in HIV/AIDS patients – Adv. Tech. In clinical Microbiology – 2017, Vol. 1, No. 3: 16.
4. Ramachandran Vignesh, Chinnambedu R Swathirajan – Risk factors and frequency of tuberculosis-associated immune reconstitution inflammatory syndrome among HIV/Tuberculosis co-infected patients in southern india – Ind. J. of Med. Microbilogy - 2017, Vol 35, Issue 2, Page 279-281.
5. Kachhi R, Saker V – Epidemiological study of TB as Major HIV-AIDS co-infection – J. Of Mathematical & Stat. Anal. – Aug 2018, Vol 1, Issue 1. Page 1 – 14.
6. Dorian Fernandez, Imoleayo Salami – HIV-TB coinfection among 57 million pregnant women, obstetric complication, alcohol use, Drug abuse, and depression – J. of Pregnancy – 2018. Articl ID 5896901.
7. Vasudeviah V (2007) HIV infection among tuberculosis patients, Indian j Tuberc 44; 97-8.
8. The Gao Report 2014.
9. Sharma Sk, Saha PK, Dixit Y, Siddaramaiah NH, Seth P, et al. (2000) HIV seropositivity among adult tuberculosis patients in Delhi. Indian J Chest Dis Allied Sci 42: 157-60.
10. Sharma Sk, Mohan A, Kadhiravan T (2005) HIV-TB co-infection: epidemiology, diagnosis and management. Indian J med Res 121: 550-67.
11. World Health Organization (2005) A guid to monitoring and evaluation for collaborative TB/HIV activities, Geneva.
12. Parriens JH, St Louis ME, Mukadi YB, Brown C, Prignot j, et al. (1995) Pulmonary tuberculosis in HIV-infected patients in Zaire. A controlled trial of treatment for either 6 or 12 months. N Engl J Med 332: 779-84.
13. Sunderam G, McDonald RJ, Maniatis T, Oleske J, Kapila R, et al.(1986) (1990) Human Immunodeficiency virus infection in tuberculosis patients. J Infect Dis 162: 8-12.
14. Assoc S, Knowles L, Rai A, Jones BE, Pogoda J, et al. (1996) Relationship of isoniazid resistance to human immunodeficiency virus infection in patients with tuberculosis. Am J Respir Crit Care Med 153: 1708-10.
15. Halvir DV, Barmes PF (1999) Tuberculosis in patients with human immunodeficiency virus infection. N EngI J Med 340: 367-73.
16. Narain JP, Lo YR (2004) Epidemiology of HIV-TB in Asia, Indian J Med Res 120: 277-89.
17. Regional strategic plan on HIV/TB (2003) World Health Organization Regional Office for South-East Asis 2003, SEA/TB/261, SEA/AIDS/140. New Delhi: World Health Organization Regional Office for South-East Asia.
18. World Health Organization Regional Office for Sout-East Asia 2008. HIV/AIDS. SEARO Publications on HIV/AID, Tuberculosis and HIV-Some Questions and answers.
19. Meintjes G, Lawn SD, Scano F, French MA, Worodria W, et al. (2008) international network for the study of HIV-associated IRIS. Tuberculosis-associated immune reconstitution inflammatory syndrome: case definitions for use in resource-limited settings, Lancet Infect Dis 8: 516-23.
20. Mcilleron H, Meintjes G, Burman WJ (2007) Complications of antiretroviral therapy in patients with tuberculosis: drug interactions, toxicity, and immune reconstitution inflammatory syndrome, J Infect Dis 1:S63-75.
21. Getahun H, Gunneberg C, Granich R, Nunn P (2010) HIV infection-associated tuberculosis: The epidemiology and the response. Clin infect Dis 50: 5201-5207.
22. Suchindran S (2009) is HIV infection a risk factor for multi-drug resistant tuberculosis? A systematic review. PLoS ONE 4: e5561.
23. The Global Fund (2015) To figh AIDS, tuberculosis and malaria, TB and HIV, concept note. Investing for impact against tuberculosis and HIV.  Single TB and HIV concept Note Albania.
24. Kumarasamy N, Venkatesh KK, Vignesh R, Devaleenal B, Poongulali S, Yepthomi T, et al. Clinical outcomes among HIV/tuberculosis-coinfected patients developing immune reconstitution inflammatory syndrome after HAART initiation in South India. JInt Assoc Provid AIDS Care 2013; 12:28-31.
25. Shankar Em, Vignesh R, Ellegard R, Barahan M, Chong YK, Bador MK, et al. HIV-Mycobacterium tuberculosis co-infection: A ‘danger-couple model’ of disease pathogenesis. Pathog Dis 2014; 70:110-8.
26. Solomon S, Balakrishnan P, Vignesh R, Waldrop G, Solomon SS, Murugavel KG, et al. A rapid and low cost microscopic observation drug susceptibility assay for detecting TB and MDR_TB among individuals infected by HIV in South India. Indian J Med Microbiol 2013; 31: 130-7.
27. Lai RP, Nakiwala JK, Meintjes G, Wilkinson RJ. The immunopathogenesis of the HIV tuberculosis immune reconstitution inflammatory syndrome. Eur J immunol 2013; 43:1995-2002.
28. Sharma SK, Mohan A and Kadhiravan T. HIV-TB co-infection: epidemiology, diagnosis & management, Indian J med res 2005; 121(4) :550-567.
29. Shastri S, Naik B, Shet A, Rewari B and De Costa A. TB Treatment outcomes among TB-HIV co-infections in Karnataka, India: how do these compare with non-HIV tuberculosis outcomes in the province ? BMC public health 2013; 13(1):838.
30. Getahun, C. Gunneberg, R. Granich, and P. Nunn, “HIV infection-associated tuberculosis: the epidemiology and the response,” Clinical infectious Diseases, Vol. 50, Supplement3, pp, S201-s207,2010.
31. J. Murray, K. Styblo, and A. Rouillon, “Tuberculosis in developing countries: burden, intervention and cost,” Bulletin of the international Union against Tuberculosis and Lung Disease, vol. 65, no. 1, pp. 6-24, 1990.
32. D. Harries, R. B. Chimzizi, T.E. Nyirenda, J. Van Gorkom, and F. M. Salaniponi, “Preventing recurrent tuberculosis in high HIV-prevalent areas in sub-Saharan Africa: What are the options for tuberculosis control programmes?” The international journal of tuberculosis and lung disease, vol. 7, no. 7, pp. 616-622, 2003.
33. L. Korenromp, F. Scano, B. G. Williams, C. Dye, and P. Nunn, “Effects of human immunodeficiency virus infection on recurrence of tuberculosis after rifampin-based treatment: An analytical review’” Clinical infectious diseases. Vol. 37, no. 1, pp. 101-112, 2003.
34. D. Zenner, I. Abubakar, S. Conti et al., “Impact of TB on the survival of people living with HIV infection in England, Wales and Northern Ireland,” Thorax, vol. 70, no. 6, pp. 566-573, 2015.

Dr K Kodanda Rao

Asst. Prof. Dept. of General Surgery GIMSR, Visakhapatnam, AP, India