DOI: https://doi.org/10.53350/pjmhs221651368 ORIGINAL ARTICLE 1368 P J M H S Vol. 16, No. 05, May 2022 Screening of HIV Infection in Patients with Pulmonary Tuberculosis at a Tertiary Care Hospital ABDUL RASHID DAYO 1 , SHAHZAD MEMON 2 , YAR MUHAMMAD TUNIO 3 , KASHIF ALI 4 , MARIA BASHEER 5 , RUQAYYA FARHAD 6 1 Assistant professor of medicine, GMMC Sukkur 2 Assistant professor of medicine, PUMHS/ Nawabshah 3,6 Assistant professor of medicine, GIMS Gambat Khairpur 4 Assiatant Professor of medicine, Bilawal Medical College for Boys LUMHS/ Jamshoro 5 Resident of medicine, GMMC Sukkur Corresponding author: Maria Basheer, Email: mariyabasheer1@yahoo.com ABSTRACT Objective: To determine the frequency of HIV infections in patients with pulmonary tuberculosis. Patients and methods: This cross-sectional study, was conducted at the Department of Medicine, Ghulam Muhammad Mehar Medical College, Sukkur, from October 2019 to 2020. All the patients had pulmonary TB of any duration; their ages ranged from 15 years to 45 years, and both genders were included. Sputum analysis for the patients with known pulmonary tuberculosis was done for AFB (Positive/Negative). Sputum was also sent for a GeneXpert test for the diagnosis of MDR TB. The patient's sputum culture and sensitivity were checked from the record and the XDR TB, if present in that record, was noted. In all patients with PTB, blood was taken and sent for serology. HIV was assessed by serology. All of the data was taken and recorded into the proforma at its completion, and was then analyzed by SPSS version 26 for the research purpose. RESULTS: The average age of the patients was 34.2±10.3 years, and the average duration of TB was 8.1±3.9 months. Out of all, 90 (64.3%) were males and 50 (35.7%) were females. In distribution for types of pulmonary tuberculosis, 1st line drug response was found in 41 (29.4%) patients, MDR TB in 60 (42.8%), while XDR TB was found in 39 (27.8%) patients. HIV infection serology was found to be positive in 53 (37.9%) patients. As per stratification, the HIV serological infection was significantly higher among males (p-0.004), while it was statistically insignificant according to the patients' age and disease status (p->0.05). CONCLUSION: It was to be concluded that the prevalence of HIV infection was documented as considerably high in patients with pulmonary tuberculosis. Therefore, all individuals having tuberculosis should be evaluated for HIV risk factors and advised to get tested. Keywords: HIV, Pulmonary Tuberculosis, Co-Infection INTRODUCTION Tuberculosis (TB) is a chronic bacterial infection caused by Mycobacterium tuberculosis, which mostly affects the lungs (pulmonary TB), but it can affect other organs as well, which is considered extrapulmonary TB. Tuberculosis (TB) is an extremely contagious disease that can spread easily and sometimes be difficult to treat. In 2016, 10.4 million new cases of tuberculosis were discovered throughout the world. 1 It has been documented and shown by WHO that in 2014, 9.6 million individuals got tuberculosis (TB) and 1.5 million people died as a result of the disease. 2,3 In 2016, Pakistan, China, Indonesia, India, and the Philippines accounted for 56% of all incident instances worldwide. Pakistan reported 518,000 tuberculosis cases in 2016, accounting for around a quarter of the total estimated incidence. Pakistan is among the six nations with the highest number of reported cases in 2014. 2 Human Immunodeficiency virus (HIV) infection causes an attack on the immune system of the body (T-Cells), rendering an immune response. HIV is an important risk factor for the development of pulmonary tuberculosis (PTB) and the emergence of multidrug-resistant strains 1/3 of M. tuberculosis. PTB co- infection with HIV has been shown in epidemiological studies to increase the probability of latent TB reactivation by 20-fold, and it is the most significant risk factor for the progression of M. tuberculosis infection to active illness. 3,4 In a South African rural area, 44 of 53 individuals having XDR TB reported HIV positive.5 Approximately 50% of India's 5.1 million HIV-positive persons are also infected with Mycobacterium tuberculosis. 6 HIV infection, along with the PTB, has been the most significant cause of morbidity and mortality since the emergence of the HIV pandemic. 2,7,8 According to the World Health Organization, tuberculosis is the most fatal infectious illness worldwide, alongside HIV. Both illnesses were identified as effective joint top killers in 2014, accounting for around 1.5 million fatalities. 2,3 During 2014, 0.4 million people living with HIV died as a result of tuberculosis (TB). 2 A study in Spain identified The prevalence of adverse outcomes in TB individuals is linked to HIV infection as a specific independent risk. 7 Post-mortem studies in resource- constrained settings in South Asia, the Americas, and Sub- Saharan Africa suggest that TB is responsible for over 40% of Aids HIV associated adult fatalities. 8 This resulted in a concurrent TB pandemic in several Sub-Saharan African communities. Pakistan has been one of the eleven nations with a high TB prevalence, and one of the six countries with the highest number of infections in 2014. 2 Most patients presented with or diagnosed with pulmonary tuberculosis neither do not know about their HIV infection status nor they are usually screen for. 9 One study showed that 38.3% of the co-infected patients responded that they had TB before learning of their HIV seropositivity. 9 Although there is a greater prevalence of tuberculosis in Pakistan, there is no proper recent study in adults available to denote the exact prevalence of HIV infections in TB patients. In a study in India, the prevalence of HIV infection among individuals having pulmonary tuberculosis is 10%. 10 This study has been done to evaluate the HIV infection prevalence among individuals presented with pulmonary tuberculosis. As HIV is growing in our society, and an HIV patient may be affected by pulmonary TB or vice versa due to decreased immunity. So, the result of this study can be used to predict such patients and in time management of such patients to decrease mortality and morbidity. MATERIAL AND METHODS This cross-sectional study was conducted at the Department of Medicine, Ghulam Muhammad Mehar Medical College, Sukkur, from October 2019 to 2020. All the patients had pulmonary TB of any duration, ages ranged from 15 years to 45 years, and both genders were included. All the known immune-compromised patient, patients with connective tissue disorder or other related disorder in which serology test became invalid were excluded. After explaining the technique, hazards, and advantages of the study, verbal informed consent was obtained from the patients or their caretakers. The approach of non-probability, consecutive sampling was employed. Sputum analysis was done for AFB (Positive/Negative). Also, sputum was sent for a GeneXpert test for the diagnosis of MDR TB. Patient sputum culture and sensitivity were checked from record and the XDR TB if presented in that record was noted. In all patients with PTB, blood was taken and