Published: 2016-12-18

Prevalence of pulmonary tuberculosis in retroviral positive chest symptomatics in a tertiary care hospital, South India

S. Anantha Sankari, R. Sridhar


Background: Human immunodeficiency virus (HIV) associated tuberculosis (TB) remains a major global public health challenge. As this co-infection results in high mortality among retroviral positive patients, we undertook this study to find its prevalence in our region.

Methods: Sputum smears from all retroviral positive patients who attended the ART clinic from April 2015 to February 2016 were examined for the presence of Mycobacterium tuberculosis bacilli by fluorescent staining technique. CD4 lymphocyte counting was also done by using BD FACS count instrument.

Results: 65 patients were retroviral positive among the 180 patients who came to ART clinic. Of them 43 (66%) were males and 22 (34%) were females. 30 (46%) of retroviral positive patients were sputum positive indicating HIV-TB co-infection. 60% of co-infected patients belong to productive age group of 16-45 years. 93.4% of the co-infected patients had CD4 counts below 350 cells/µl. sputum negative retroviral positive patients had more than 250 CD4 cells/ µl.

Conclusions: Our study highlights the fact that HIV-TB co-infection is more prevalent in productive age group and has a positive correlation with lower CD4 counts.


HIV, Mycobacterium tuberculosis, CD4 lymphocyte, HIV-TB co-infection

Full Text:



WHO report 2010. Global tuberculosis control. Available from: tb/publications/ global_report/en/ accessed on September 20, 2011.

Sonnenberg P, Glynn JR, Fielding K, Murray J, Godfrey-Faussett P, Shearer S. How soon after infectionwith HIVdoes the risk of tuberculosis start to increase? A retrospective cohort study in South African gold miners. J Infect Dis. 2007;191:150-8.

Corbett EL, Watt CJ, Walker N, Maher D, Williams BG, et al. The growing burden of tuberculosis: global trends and interactions with the HIV epidemic. Arch Intern Med. 2003;163:1009-21.

Lawn S, Churchyard G. Epidemiology of HIV associated tuberculosis. Curr Opin HIV AIDS 2009;4:325-33.

Getahun H, Gunneberg C, Granich R, Nunn P. HIV infection- associated tuberculosis: the epidemiology and the response. Clin Infect Dis. 2010;50 Suppl 3:S201-7.

Selwyn PA, Hartel D, Lewis VA, Schoenbaum EE, Vermund SH, et al. A prospective study of the risk of tuberculosis among intravenous drug users with human immunodeficiency virus infection. N Engl J Med. 1989;320:545-50.

Collins KR, Quinones-Mateu ME, Toossi Z, Arts EJ. Impact of tuberculosis on HIV-1 replication, diversity, and disease progression. AIDS Rev. 2002;4:165-76.

Aaron L, Saadoun D, Calatroni I, Launay O, Memain N, et al. Tuberculosis in HIV-infected patients: a comprehensive review. Clin Microbiol Infect. 2004;10:388-98

Whalen C, Horsburgh CR, Hom D, Lahart C, Simberkoff M, et al. Accelerated course of human immunodeficiency virus infection after tubercu- losis. Am J Respir Crit Care Med. 1995;151:129-35.

Moller M, Hoal EG. Current findings, challenges and novel approaches in human genetic susceptibility to tuberculosis. Tuberculosis (Edinb) 2010;90: 71–83.

Global Report. UNAIDS report on the global AIDS epidemic 2010. Available from: documents/ 20101123_GlobalReport_full_en.pdf, accessed on September 20, 2011

National AIDS Control Organisation (NACO) – Estimation of HIV infection in India: http:// AIDS Profile: India ipc/www/ hivctry.html

Potts M, Walsh J. Tackling India’s HIV epidemic: lessons from Africa. British Medical Journal. 2003;326:1389-92.

Nagelkerke NJD, Jha P, Vlas SJD, Korenromp EL, Moses S, Blanchard JF, et al. Modelling HIV/AIDS epidemics in Botswana and India: impact of interventions to prevent transmission. Bulletin of the World Health Organization. 2002;80(2):89-96.

Williams BG, Granich R, Chauhan LS, Dharmshaktu NS, Dye C. The impact of HIV/AIDS on the control of tuberculosis in India. PNAS. 2005;102(27):9619-24.

Joshi PL, Chauhan LS, et al. Guidelines for management of HIV-TB co-infection. National AIDS Control Organization, in press. 2004.

Centers for Disease Control and Prevention. Transmission of multidrug-resistant tuberculosis among immunocompromised persons in a correctional system- New York, 1991. MMWR Morb Mortal Wkly Rep. 1992;41:507-9.

Centers for Disease Control and Prevention. Outbreak of multidrug-resistant tuberculosis at a hospital - New York City. 1991. MMWR Morb Mortal Wkly Rep. 1993;42(427):433-4.

Pearson ML, Jereb JA, Frieden TR, Crawford JT, Davis BJ, Dooley SW, et al. Nosocomial transmission of multidrug-resistant Mycobacterium tuberculosis. A risk to patients and health care workers. Ann Intern Med. 1992;117:191-6.

Beck-Sague C, Dooley SW, Hutton MD, Otten J, Breeden A, Crawford JT, et al. Hospital outbreak of multidrug-resistant Mycobacterium tuberculosis infections. Factors in transmission to staff and HIV-infected patients. JAMA. 1992;268:1280-6.

Vernon A, Burman W, Benator D, Khan A, Bozeman L. Acquired rifamycin monoresistance in patients with HIV- related tuberculosis treated with once-weekly rifapentine and isoniazid. Tuberculosis Trials Consortium. Lancet. 1999;353:1843-7.)

Havlir DV, Barnes PF. Tuberculosis in patients with human immunodeficiency virus infection. N Engl J Med. 1999;340:367-73.

Jones BE, Young SM, Antoniskis D, Davidson PT, Kramer F, Barnes PF. Relationship of the manifestations of tuberculosis to CD4 cell counts in patients with human immunodeficiency virus infection. Am Rev Respir Dis. 1993;148:1292-7.

Zumla A, Malon P, Henderson J, Grange JM. Impact of HIV infection on tuberculosis. Postgrad Med J. 2000;76:259-68.

Perlman DC, el-Sadr WM, Nelson ET, Matts JP, Telzak EE, Salomon N, et al. Variation of chest radiographic patterns in pulmonary tuberculosis by degree of human immunodeficiency virus-related immunosuppression. The Terry Beirn Community Programs for Clinical Research on AIDS (CPCRA). The AIDS Clinical Trials Group (ACTG). Clin Infect Dis. 1997;25:242-6.

World Health Organization (2010) Global tuberculosis control 2010. Available: tb/ publications/ global_report/ 2010/en/index.html. Ac- cessed 13 January 2012.

UNAIDS. Chapter 2: epidemic update. UNAIDS report on the global AIDS epidemic. 2010. Available: documents/ 20101123_GlobalReport_Chap2_em.pdf. Accessed 13 January 2012.

Govt. of India, Ministry of Health and Family. Welfare, National AIDS Control Organisation. National guidelines for clinical management of HIV/AIDS. 2003. Accessed November 15, 2011. at

Kaiser Weekly TB/Malaria Report. HIV/TB co-epidemic rapidly is spreading in sub-Saharan Africa. Accessed November 2, 2011. at Daily-Reports/ 2007/02/dr00048620aspx

Sharma SK, Agarwal G, Seth P, Saha PK. Increasing seropositivity among adult tuberculosis patients in Delhi. Indian J Med Res. 2003;117:239-42.

Paranjape RS, Tripathy SP, Menon PA, Mehendale SM, Khatavkar P, Joshi DR. Increasing trend of HIV seroprevalence among pulmonary tuberculosis patients in Pune, India. Indian J Med Res. 1997;106:207-11.

Giri PA. Jayant D DeshpandeDeepak B Phalke N Prevalence of Pulmonary Tuberculosis Among HIV Positive Patients Attending Antiretroviral Therapy Clinic. Am J Med Sci. 2013;5(6):367-70.