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.
Aim: We
determined the factors associated with prevalent TB among patients receiving HAART.
Subjects and 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).
Conclusion: 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.

Keywords: Factors, Highly active antiretroviral therapy, Human immunodeficiency virus, Prevalent, Tuberculosis