International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases | 2021
Lack of latent tuberculosis screening and delay in Anti-Retroviral Therapy initiation in HIV-TB co-infection: A 11-year study in an intermediate TB-burden country.
Abstract
OBJECTIVES\nOur study examined the prevalence and characteristics of HIV-TB co-infected patients in Singapore, an intermediate TB-burden country.\n\n\nMETHODS\nRetrospective data of 11-years was obtained from the National University Hospital (NUH), a quaternary hospital and the National Centre for Infectious Diseases (NCID), the national HIV center.\n\n\nRESULTS\nFrom December 2005 to December 2016, 4,015 HIV-infected patients were managed at NUH and NCID, of whom 48 and 272 were diagnosed with active TB disease respectively. Only 2 patients (0.6%) were screened for latent TB infection on HIV diagnosis. Mean CD4 count at TB diagnosis was 125.0 ± 153.9 cells/mm3. Patients with HIV diagnosed ≥6 weeks before TB (41%) were associated with higher CD4 counts >200 cells/mm3, compared to patients with TB diagnosed ≥6 weeks before HIV (2%). 124 (38.6%) HIV-TB patients had CD4<50 cells/mm3. 33.5% with pulmonary TB had normal chest X-ray. Amongst HIV-TB co-infected patients with CD4≤50 cells/mm3, only 18 (14.2%) had anti-retroviral therapy (ART) started <2 weeks.\n\n\nCONCLUSIONS\nLatent TB infection screening in HIV-infected patients is low and ART initiation is delayed in HIV-TB patients with CD4 ≤ 50 cells/mm3. Pulmonary TB patients with HIV can be infectious despite a normal chest X-ray. Clinical practices can be further improved to benefit HIV-TB patients.