Prevalence and Predictors of CD4+ T-Lymphocytopenia Among HIV-Negative Tuberculosis Patients in Uganda

Viral Load and CD4+ Markers as Determinants of Tuberculosis Coinfection Among People Living with HIV/AIDS in Papua Indonesia

Tuberculosis (TB) infection causes mortality among People Living with HIV (PLHIV), so the treatment of TB-HIV coinfection is crucial. The study aimed to identify the determinants contributing to TB coinfection among PLHIV in Papua. It is a descriptive-analytic study with a cross-sectional design involving 188 PLHIV at the four hospitals in Papua. CD4+ was carried out using CD4+ counter and viral load using the qPCR technique. A logistic regression test and R statistic with a significance level of 0.05 were used to analyze the determinants of TB coinfection among PLHIV. PLHIV having CD4+ count of fewer than 350 cells/mm3 had a 17.8 times higher risk for TB-HIV coinfection, P-value = 0.0. In addition, a viral load of more than 10 000 copies/ml will be 12.1 times more likely to be co-infected with TB-HIV compared to those who have a viral load of fewer than 10 000 copies/ml, P-value = 0.0. CD4+ markers and viral load are factors that play a role in TB coinfection among PLHIV in Papua Province.

Prevalence of anaemia and associated factors among people with pulmonary tuberculosis in Uganda

Anaemia predicts delayed sputum conversion and mortality in tuberculosis (TB). We determined the prevalence and factors associated with anaemia among people with TB at the National Tuberculosis Treatment Centre in Uganda. People with bacteriologically confirmed TB were consecutively enrolled in a cross-sectional study between August 2017 and March 2018. Blood samples were tested for a full blood hemogram, HIV infection, and CD4+ and CD8+ T-cell counts. Anaemia was defined as a haemoglobin level of <13.0 grams per decilitre (g/dl) for males and <12.0 g/dl for females. Of 358 participants, 210 (58.7%, 95% confidence interval (CI) 53.4–63.8) had anaemia. Anaemia was associated with night sweats, a longer duration of fever, low body mass index (BMI), hyperthermia, high sputum bacillary loads, HIV co-infection, and low CD4 and CD8 counts at bivariate analysis. Factors associated with anaemia at multivariable analysis were low BMI (odds ratio (OR) 2.93, 95% CI 1.70–5.05, P < 0.001), low CD4:CD8 ratio (OR 2.54, 95% CI 1.07–6.04, P = 0.035) and microcytosis (OR 4.23, 95% CI 2.17–8.25, P < 0.001). Anaemia may be associated with the features of severe TB disease and should be considered in TB severity scores.

Clinical features of and diagnostic approaches for abdominal tuberculosis: 5-year experience from a non-tuberculosis-designated hospital in China

BACKGROUND AND PURPOSE

Abdominal tuberculosis (TB) is a common form of extrapulmonary TB but is still a diagnostic dilemma in clinical practice. We are aimed to highlight the clinical features of and diagnostic approaches for abdominal TB.

METHODS

Seventy cases of diagnosed abdominal TB were retrospectively collected at Zhongshan Hospital, Fudan University in Shanghai, China, between 1 August 2015 and 30 June 2020. They were classified as peritoneal TB, lymph node TB, gastrointestinal TB, visceral TB, or mixed TB.

RESULTS

Eighteen patients were diagnosed with peritoneal TB, 9 with lymph node TB, 5 with gastrointestinal TB, 2 with visceral TB, and 36 with mixed TB. Twenty-four patients had only abdominal TB, while 7 had abdominal TB combined with pulmonary TB (PTB), 19 had abdominal TB combined with extrapulmonary TB (EPTB) in one or more sites, and 20 had abdominal TB combined with both PTB and EPTB in other sites. The median diagnosis time was 60 days. Ascites(58.6%), abdominal distension(48.6%), weight loss(44.3%) and fever(42.9%) were the most common symptoms. The overall microbiological and histological confirmation rates were 70.0% and 38.6% respectively. The non-ascites samples yielded a higher microbiological confirmation rate (63.6%) than the total samples (40.8%). Diagnosis was confirmed histologically in 18 patients (69.2%). Forty-five cases (64.3%) were clinically diagnosed. Invasive procedures such as surgery (6/7), percutaneous biopsy (7/7) and endoscopy in lymph node TB (4/5) had high confirmation rates.

CONCLUSIONS

The diagnosis of abdominal TB should be reached by a combination of clinical, laboratorial, radiographic, microbiological and pathological findings.

Gender differences among patients with drug resistant tuberculosis and HIV co-infection in Uganda: a countrywide retrospective cohort study

BACKGROUND

Gender differences among patients with drug resistant tuberculosis (DRTB) and HIV co-infection could affect treatment outcomes. We compared characteristics and treatment outcomes of DRTB/HIV co-infected men and women in Uganda.

METHODS

We conducted a retrospective chart review of patients with DRTB from 16 treatment sites in Uganda. Eligible patients were aged ≥ 18 years, had confirmed DRTB, HIV co-infection and a treatment outcome registered between 2013 and 2019. We compared socio-demographic and clinical characteristics and tuberculosis treatment outcomes between men and women. Potential predictors of mortality were determined by cox proportional hazard regression analysis that controlled for gender. Statistical significance was set at p < 0.05.

RESULTS

Of 666 DRTB/HIV co-infected patients, 401 (60.2%) were men. The median (IQR) age of men and women was 37.0 (13.0) and 34.0 (13.0) years respectively (p < 0.001). Men were significantly more likely to be on tenofovir-based antiretroviral therapy (ART), high-dose isoniazid-containing DRTB regimen and to have history of cigarette or alcohol use. They were also more likely to have multi-drug resistant TB, isoniazid and streptomycin resistance and had higher creatinine, aspartate and gamma-glutamyl aminotransferase and total bilirubin levels. Conversely, women were more likely to be unemployed, unmarried, receive treatment from the national referral hospital and to have anemia, a capreomycin-containing DRTB regimen and zidovudine-based ART. Treatment success was observed among 437 (65.6%) and did not differ between the genders. However, mortality was higher among men than women (25.7% vs. 18.5%, p = 0.030) and men had a shorter mean (standard error) survival time (16.8 (0.42) vs. 19.0 (0.46) months), Log Rank test (p = 0.046). Predictors of mortality, after adjusting for gender, were cigarette smoking (aHR = 4.87, 95% CI 1.28-18.58, p = 0.020), an increase in alanine aminotransferase levels (aHR = 1.05, 95% CI 1.02-1.07, p < 0.001), and history of ART default (aHR = 3.86, 95% CI 1.31-11.37, p = 0.014) while a higher baseline CD4 count was associated with lower mortality (aHR = 0.94, 95% CI 0.89-0.99, p = 0.013 for every 10 cells/mm³ increment).

CONCLUSION

Mortality was higher among men than women with DRTB/HIV co-infection which could be explained by several sociodemographic and clinical differences.

Undernutrition and Treatment Success in Drug-Resistant Tuberculosis in Uganda

Background

Undernutrition is associated with unfavourable treatment outcomes among people with drug-resistant tuberculosis (DRTB). Factors influencing the treatment outcomes among undernourished people with DRTB are not well characterised. The aim of this study was to determine factors associated with treatment success among undernourished people with DRTB in Uganda.

Methods

We analysed data from a retrospective cohort of people with DRTB from 16 treatment sites in Uganda. We included participants with a pre-treatment body mass index (BMI) of <18.5 kilograms/meters² (kg/m²). Participants were categorised as having mild (BMI of 18.5–17 kg/m²), moderate (BMI of 16.9–16.0 kg/m²) or severe (BMI of <16.0 kg/m²) undernutrition. We performed logistic regression analysis to determine factors associated with treatment success.

Results

Among 473 people with DRTB, 276 (58.4%) were undernourished (BMI < 18.5 Kg/m²) and were included in the study. Of these, 92 (33.3%) had mild, 69 (25.0%) had moderate and 115 (41.7%) had severe undernutrition. The overall treatment success rate (TSR) for the undernourished was 71.4% (n = 197). Although the TSR was similar among participants with mild (71.7%), moderate (78.3%) and severe (67.0%) undernutrition (p = 0.258), all treatment failure cases (n =6) were among participants with severe undernutrition (p = 0.010). Cigarette smoking (odds ratio (OR) = 0.19, 95% CI 0.07–0.47, p < 0.001), urban residence (OR = 0.31, 95% CI 0.14–0.70, p = 0.005) and moderate (OR = 0.14, 95% CI 0.06–0.35, p < 0.001) and severe anaemia (OR = 0.06, 95% CI 0.01–0.29, p = 0.001) were associated with lower odds of treatment success.

Conclusion

Most undernourished people with DRTB have severe undernutrition. Smoking and anaemia are modifiable factors which upon appropriate intervention could improve treatment success. The effect of urban residence on the TSR needs to be evaluated further.