Volume 6, Issue 4, July 2018, Page: 38-44
Clinical Risk Factors Associated with HIV-Tuberculosis Co-Infection Among Patients on Antiretroviral Therapy, Bungoma and Webuye County Hospitals (2015), Kenya
Robert Shihuzire Magomere, County Coordinating Tuberculosis and Leprosy Services, Bungoma, Kenya
Ronald Omenge Obwoge, Department of Community Health, Faculty of Health Sciences, Egerton University, Nakuru, Kenya
Received: Aug. 25, 2017;       Accepted: Sep. 7, 2017;       Published: Sep. 19, 2018
DOI: 10.11648/j.ejpm.20180604.11      View  325      Downloads  18
Abstract
Tuberculosis (TB) is the leading causes of death among people living with Human Immune Deficiency Virus (HIV) and first presenting sign in majority of people living with HIV. Factors influencing TB among HIV patients on anti retroviral treatment (ART) are not well described in our settings. The study aimed to assess clinical factors influencing occurrence of TB among people living with HIV after ART initiation in Bungoma and Webuye hospitals in Bungoma County. The study population consists of 156 cases and 156 controls. Case control study conducted from January 2017- April 2017 in two public hospitals in Bungoma County. Cases were adult people living with HIV who developed TB after ART initiation and controls were adult people living with HIV who did not develop TB after ART initiation. An interviewer administered structured questionnaire was used to collect information. at 95% CI and variables with p-value of < 0.05 at multivariable logistic regression were considered as significant predictors of the outcome variable. The findings of the study were presented in text and tables. The result of this study shows that after adjusting for potential confounders not being on Isonazid (adjusted odd ratio [AOR] = 35.97, 95% confidence interval [CI] 13.81, 90.20), ), having World Health Organization (WHO) clinical stage III/IV (AOR = 15.53; 95% CI: 7.67, 31.47), having interrupted ART (AOR=2.72; 95%CI: 0.35,21.31), were predictors for increase risk of TB in PLWH after ART initiation. Not smoking (AOR=0.31;95%CI:0.13,0.71) had decreases chances of acquiring TB in PLWH after ART initiation. In this study, increasing coverage of isoniazid preventive therapy reduced risk of TB among HIV patients. Study recommends that all PLWH should be screened for TB, but for patients who have advanced disease condition (WHO clinical stage III/IV) intensified screening is highly recommended during treatment follow up.
Keywords
Antiretroviral Therapy, Co-Infection, Clinical Characteristics
To cite this article
Robert Shihuzire Magomere, Ronald Omenge Obwoge, Clinical Risk Factors Associated with HIV-Tuberculosis Co-Infection Among Patients on Antiretroviral Therapy, Bungoma and Webuye County Hospitals (2015), Kenya, European Journal of Preventive Medicine. Vol. 6, No. 4, 2018, pp. 38-44. doi: 10.11648/j.ejpm.20180604.11
Copyright
Copyright © 2018 Authors retain the copyright of this article.
This article is an open access article distributed under the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Reference
[1]
World Health Organization, Tuberculosis Fourth Edition, The Essentials, Edited By Dr Mario C. Raviglione, World Health Organization, Geneva Switzerland, 2010, http://www.who.int/ tb/features archive/the essentials/en/.
[2]
World Health Organization, Promoting the Implementation of Collaborative TB/HIV Activities through Public-Private Mix and Partnerships Report of a WHO Consultation, World Health Organization, Geneva, Switzerland, 2008, http://whqlibdoc .who.int/hq/2008/WHO HTM TB 2008.408 eng.pdf.
[3]
World Health Organization (2011) Global tuberculosis control report. WHO 2011, Geneva
[4]
World Health Organization. Global Tuberculosis [Internet]. Vol. 312, Jama. GENEVA; 2013. Available from: http://www.ncbi.nlm.nih.gov/pubmed/25188638
[5]
Department of Tuberculosis. National Tuberculosis, Leprosy and Lung Disease Program; annual report,2015 [Internet]. NAIROBI; 2015. Annual Report 2015 .pdf
[6]
Habib AG (2009) A clinical and epidemiologic update on the interaction between tuberculosis and human immunodeficiency virus infection in adults. Annals of African Medicine 8(3): 147-155.
[7]
Preliminary report for the U.S. Office of the Global AIDS Coordinator (2004) Integrating HIV/AIDS & TB Efforts. The Challenge for the President’s AIDS Initiative. Network Public Health. February, 2004.
[8]
Boccia D, James H, Bianca LDS, Katherine F, Chaap AbS, et al. (2011) The Association between Household Socioeconomic Position and Prevalent Tuberculosis in Zambia: A Case-Control Study. PLoS ONE 6(6): e20824.doi:10.1371/ journal.pone.0020824.
[9]
Baalwa Joshua, Mayanja-Kizza H, Kamya MR, John L, Kambugu A, et al (2008) Worsening and unmasking of tuberculosis in HIV-1infected patients after initiating highly active anti-retroviral therapy in Uganda. African Health Sci 8(3): 190–195
[10]
Taha M, Derbew A., Tessema F, Assegid S, Duchateau L, et al (2001) Risk factors of active tuberculosis in people living with HIV/AIDS in southwest Ethiopia: a case control study. Ethiop J Health Sci 21(2): 131–139.
[11]
Lienhardt C, Fielding K, Sillah JS, Bah B, Gustafson P, et al. (2005) Investigation of the risk factors for tuberculosis: a case-control study in three countries in West Africa. Int J of Epidemiol 34: 914-923.
[12]
Perez A, Brown HS, Restrepo BI (2006) Association between tuberculosis and diabetes in the Mexican border and non-border regions of Texas. Am J Trop Med Hyg 74(4): 604-611.
[13]
World Health Organization (2011) Guidelines for intensified tuberculosis case finding and isoniazid preventive therapy for people living with HIV in resource constrained settings. WHO, Geneva, 2011.
[14]
Komati S, Shaw PA, Stubbs N, Mathibedi MJ, Malan L, et al. (2010) Tuberculosis Risk Factors and Mortality for HIV Infected Persons Receiving Antiretroviral Therapy in South Africa. AIDS 24(12):1849–1855. doi:10.1097/QAD.0b013e32833a2507.
[15]
World Health Organization (2010) Global tuberculosis control: a short update to the 2012 report, Geneva. WHO 2010 (WHO/HTM/TB/2010.7).
[16]
KNBS report, Kenya National Bureau of statistics, 2009
[17]
Kipruto H,, Mung’atu J, Ogila K, Adem A, Mwalili S, Masini E and Kibuchi E (2015) The epidemiology of tuberculosis in Kenya, a high TB/HIV burden country (2000-2013) International Journal of Public Health and Epidemiology Research Vol. 1(1), pp. 002-013, October, 2015.
[18]
Fleming MF, Krupitsky E, Tsoy M, Zoartau E, Brazhenko N, et al. (2006) Alcohol and drug use disorders, HIV status and drug resistance in a sample of Russian Patients. International Journal of Tuberculosis and Lung Disease.
[19]
Young F, Wotton CJ, Critchley JA, Unwin NC, Goldacre MJ (2012). Increased risk of tuberculosis disease in people with diabetes mellitus: record-linkage study in a UK population. J Epidemiol Community Health. 2012;66(6):519–23.
[20]
Heitham Awadalla, Fateh El-Samani , Mohammed A. Soghaier 3, and Mahgoub Makki Risk Factors Associated with the Development of Tuberculosis Among HIV-Infected Patients in Khartoum in 2010 AIMS Public Health, 2 (4): 784-792 DOI: 10.3934/publichealth.2015.4.784 2015.
[21]
Lienhardt C, Fielding K, Sillah J, Tunkara A, Donkor S, Manneh K, et al (2003). Risk factors for tuberculosis infection in Sub-Saharan Africa. Am J Respir Crit Care Med. 2003;168(4):448–55.
[22]
Hill. P. C, D. Jackson-Sillah, S. A. Donkor, J. Otu, R. A. Adegbola, and C. Lienhardt, “Risk factors for pulmonary tuberculosis: a AIDS Research and Treatment 7 clinic-based case control study in The Gambia,” BMC Public Health, vol. 6, no. 156, 2006.
[23]
Gallagher. M, “Marriage and Public Health: Institute for American Values The Case for Marriage,” 2001, USA, http://www .americanvalues.org/.
[24]
Dheeraj Gupta, Kshaunish Das, Balamughesh T, Ashutosh N. Aggarwal and Surinder. K. Jindal (2003) role of socio-economic factors in tuberculosis prevalence, Indian J Tuberc 2004, 51: 27-31.
[25]
Hatoluf Melkamu, Berhanu Seyoum, and Yadeta Dessie (2013) Determinants of Tuberculosis Infection among Adult HIV Positives Attending Clinical Care in Western Ethiopia A Case-Control Study Hindawi Publishing Corporation AIDS Research and Treatment Volume 2013, Article ID 279876, 7 http://dx.doi.org/10.1155/2013/279876.
[26]
Dye. C, K. Lonnroth, E. Jaramillo, B. G. Williams and M. Raviglione, “Trends in Tuberculosis Incidence and Their Determinants in 134 Countries,” Bulletin of World Health Organization, Vol. 87, No. 9, 2009, pp. 683-691. doi:10.2471/BLT.08.058453.
[27]
Perpetual Wangui Ndungu1, Gunturu Revathi, Samuel Kariuki, Zipporah Ng’ang’a Risk Factors in the Transmission of Tuberculosis in Nairobi: A Descriptive Epidemiological Study Advances in Microbiology, 2013, 3, 160-165
[28]
Amwayi A. S, Kikuvi GM, Muchiri EM. Modifiable factors associated with active pulmonary tuberculosis in a Kenyan prison. East Africa medical jounal 87(2):43-8. 2010.
[29]
Komati S, Shaw PA, Stubbs N, Mathibedi MJ, Malan L, et al. (2010) Tuberculosis Risk Factors and Mortality for HIV Infected Persons Receiving Antiretroviral Therapy in South Africa. AIDS 24(12):1849–1855. doi:10.1097/ QAD.0b013e32833a2507.
[30]
Kibret KT, Yalew AW, Belaineh BG, Asres MM (2013) Determinant Factors Associated with Occurrence of Tuberculosis among Adult People Living with HIV after Antiretroviral Treatment Initiation in Addis Ababa, Ethiopia: A Case Control Study. PLoS ONE 8(5): e64488. doi:10.1371/journal.pone.0064488.
[31]
Mupere. E, S. Zalwango, A. Chiunda, A. Okwera, R. Mugerwa, and C. Whalen, “Body composition among HIV-seropositive and HIV-seronegative adult patients with pulmonary tuberculosis in Uganda,” Annals of Epidemiology, vol. 20, no. 3, pp. 210-216, 2010.
[32]
Hatoluf Melkamu, Berhanu Seyoum, and Yadeta Dessie (2013) Determinants of Tuberculosis Infection among Adult HIV Positives Attending Clinical Care in Western Ethiopia A Case-Control Study Hindawi Publishing Corporation AIDS Research and Treatment Volume 2013, Article ID 279876, http://dx.doi.org/10.1155/2013/279876
[33]
Maurya. V, V. K. Vijayan, and A. Shah, “Smoking and tuberculosis: an association overlooked,” International Journal of Tuberculosis and Lung Disease, vol. 6, no. 11, pp. 942–951, 2002.
[34]
Arcavi. L, andN. L. Benowitz, “Cigarette smoking and infection,” Archives of Internal Medicine, vol. 164, no. 20, pp. 2206-2216, 2004.
[35]
Yanbaeva. D,G, M. A. Dentener, E. C. Creutzberg, G. Wesseling, and E. F. M. Wouters, “Systemic effects of smoking,” Chest, vol. 131, no. 5, pp. 1557–1566, 2007.
[36]
Bates. M. N, A. Khalakdina, M. Pai, L. Chang, F. Lessa, and K. R. Smith, “Risk of tuberculosis from exposure to tobacco smoke: a systematic review and meta-analysis,” Archives of Internal Medicine, vol. 167, no. 4, pp. 335–342, 2007.
[37]
Slama. K, C. Y. Chiang, D. A. Enarson et al., “Tobacco and tuberculosis: a qualitative systematic review and meta-analysis,” International Journal of Tuberculosis and Lung Disease, vol. 11, no. 10, pp. 1049–1061, 2007.
[38]
Pai. M, A. Mohan, K. Dheda et al., “Lethal interaction: the colliding epidemics of tobacco and tuberculosis,” Expert Review of Anti-Infective Therapy, vol. 5, no. 3, pp. 385–391, 2007.
[39]
Sopori. M, “Effects of cigarette smoke on the immune system,” Nature Reviews Immunology, vol. 2, no. 5, pp. 372-377, 2002.
[40]
Wang. H, M. Yu, M. Ochani et al., “Nicotinic acetylcholine receptor 𝛼7 subunit is an essential regulator of inflammation,” Nature, vol. 421, no. 6921, pp. 384–388, 2003.
[41]
L¨onnroth. K. L, B. G. Williams, S. Stadlin, E. Jaramillo, and C. Dye, “Alcohol use as a risk factor for tuberculosis-a systematic review,” BMC Public Health, vol. 8, article 289, 2008.
[42]
Akolo C, Adetifa I, Shepperd S, Volmink J (2010) Treatment of latent tuberculosis infection in HIV infected persons. Cochrane Database Syst Rev (1): CD000171.
[43]
Golub JE, Saraceni V, Cavalcante SC, Pacheco AG, Moulton LH, et al. (2007) The impact of antiretroviral therapy and isoniazid preventive therapy on tuberculosis incidence in HIV-infected patients in Rio de Janeiro, Brazil. AIDS 21(11): 1441-8.
[44]
Lawn SD, Wood R, Cock KMD, Kranzer K, Lewi JJ, et al. (2010) Antiretroviral and isoniazid preventive therapy in the prevention of HIV-associated tuberculosis in settings with limited health-care resources. Lancet Infect Dis 10: 489-98.
[45]
Churchyard GJ, Fielding K, Charalambous S, Day JH, Corbett EL, et al. (2003) Eficacy of secondary isoniazid preventive therapy among HIV-infected Southern Africans: time to change policy? AIDS 17: 2063–2070.
[46]
Lawn. S and L. G. Bekker, (2009) “Co pathogenesis of Tuberculosis and HIV,” in Tuberculosis: A Comprehensive Clinical Reference, pp. 96–106, Elsevier, 2009.
[47]
Cheru Tesema Takele Tadesse Mulat Gebrehiwot Azanaw Tsegaw Fitsum Weldegebrea l4 Environmental and host-related determinants of tuberculosis in Metema district, north-West Ethiopia Drug, Healthcare and Patient Safety 2015: 7 87–95.
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