Clinical Profile of Patients with Disseminated Tuberculosis (DTB) in Human Immune Deficiency Virus (HIV) Infection

Abstract

Background: We evaluated the clinical profile of HIV positive patients freshly diagnosed with Disseminated Tuberculosis (DTB) and assessed their response to Anti-tuberculosis treatment (ATT). Aim: To describe various clinical, radiological and pathological parameters encountered in patients of Disseminated Tuberculosis having an HIV co-infection and assessing the response to standard ATT. Settings and Design: This study is a descriptive study. Materials and Methods: We conducted a study on 54 patients of disseminated TB with HIV coinfection who were already on Anti-retroviral therapy. Assessment was focused on mode of diagnosis and distribution of organ involvement. Four months of HRZE and two months of HRE were prescribed as the standard ATT. Effect of this treatment was observed on change in weight, CD 4+ counts and HIV RNA viral loads. Statistical analysis used: Wilcoxon Sign Rank Test for assessing response to ATT. Results: This study included 54 patients. The lymphatic system was the most commonly involved organ system (64.81%) and other organs involved were the liver (55.56%), the lungs (46.3%), the pleurae (12.96%), the meninges (5.54%) and the bone marrow (3.71%). Median weight at baseline was 53 kg (IQR, 49-58) and after six months of standard ATT was 62 kg (IQR, 58-67) (p<0.001). Median CD 4+ count at baseline was 107.5 cells /mm 3 (IQR, 51.5-150.75) and after six months of standard ATT was 246 cells /mm 3 (IQR, 184-335.75) (p<0.001). Median HIV RNA viral load at baseline was 2,83,575 copies/mL (IQR, 1,78,376.25-3,83,370) and after six months of standard ATT was 19,916.5 copies/mL (14,376.25-28,622.5) (p<0.001). Conclusion: DTB in HIV positive patients has a variety of clinical manifestations which should be incorporated in the clinical decision making and change in weight, CD 4+ count and HIV RNA viral load is a reliable indicator of therapeutic response in such cases.