医療微生物学と診断

Prevalence of Tuberculosis among HIV Positive Individuals with Asymptomatic Disease States at St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia

Abstract

Semaria Solomon, Yared Asmare, Bekele Taddesse, Shewalem Negah, Yeshiwendem Mamuye, Berehanu Yitayew, Zelalem Yaregal, Ephrem Tesfaye and Abebaw Kebede

Background: There is evidence that symptom screening for TB in HIV positive individuals misses the appropriate investigative procedures to confirm for proper diagnosing of TB. High value should be placed in ensuring that TB is diagnosed early in HIV positive individuals, which have an increased likelihood of having undetected TB and high risk of poor health outcomes in the absence of early diagnosis and treatment. Objective: The aim of the study was to determine the prevalence of TB among HIV positive individuals with asymptomatic states at St. Paul’s Hospital millennium Medical College Addis Ababa, Ethiopia. Methods: A cross-sectional study was conducted from May to August, 2014 at SPHMMC. The study included 95 (34 male and 61 female) HIV positive individuals with no TB symptoms (current cough, fever, night sweat, and weight loss). Structured questionnaire was used to collect socio-demographic and clinical related data. The prevalence of TB was determined on the basis of AFB, Xpert MTB/RIF findings and diagnosis with chest X-ray. Result: Out of the 95 participants, the prevalence of undiagnosed Tuberculosis among asymptomatic HIVpatients was 1.1%. The socio-demographic characteristics and related risk factors were not significantly associated with TB finding rate by smear positive and Xpert assay. Our finding also showed a 27% abnormal chest X- ray suggestive of TB. In these HIV positive participants, presence of a patient with previous TB history was significantly abnormal by chest X-ray finding than a patient without TB history. Conclusion: The present finding of asymptomatic undiagnosed Pulmonary TB among HIV-patient is 1.1% (both with AFB and Xpert) in the study area. This showed there is a chance of transmissions of TB to contacts before the proper diagnosis and treatment is made. While the symptom screening algorithm missed the 1.1% TB cases, the AFB technique was able to detect the asymptomatic and missed TB case that was also detected by Xpert assay. TB control programs must consider TB disease prevalence when estimating the possible performance of any screening algorithm. National TB control program should weigh the risks, benefits and cost of screening all asymptomatic and symptomatic HIV infected individuals for TB by Xpert assay.