There are some clinical features, which suggest emergence of drug resistance in patients who are on anti TB treatment and suspected by the persistence of symptoms. When these patients have co-infection with HIV, does there presentation differ?
352 pulmonary TB cases were included in this study, whose sputum smear for AFB & culture were positive for M tuberculosis. All were having resistant to one or more than one anti TB drugs. 310 patients were HIV sero-negative while 42 were HIV sero-positive. Their clinical symptoms and sign were studied. The duration of illness was also noted. A study of their clinical presentation was analyzed among HIV sero-positive & negative group.
Among 310 HIV sero-negative pulmonary TB cases, the symptoms were cough with/without expectoration (69.5%) followed by fever (65.9%), weight loss (63.04%) anorexia(60.80 %), breathlessness (47.4%) chest pain (45.36%), haemoptysis (16.5%), extra pulmonary involvement (9.27%) and lymph node enlargement (6.8%). The duration of illness was more then 2 Yr. in 78.32% cases. Among 42 HIV sero-positive cases, fever was in (82.75%) followed by cough (75.86%), weight loss (72.42%),anorexia (65.17%) breathlessness (55.17%), chest pain (41.37%), haemoptysis (13.95%), extra pulmonary involvement (11.2%) and lymph node enlargement was in 8.4% cases. The duration of illness was short and majority (62.8%) cases were within 2 years.
The clinical presentation was same in both groups. Though extra pulmonary involvement was higher in HIV sero-positive group, but statistically insignificant. There were no distinctive clinical manifestation among drug resistance. HIV Sero-positive or negative group. The progression of disease was more rapid among the HIV positive patients.
Studies from western world shows the extra pulmonary involvement is more in HIV infected cases than pulmonaryinvolvement. But in our study (INDIA) the high pulmonary involvement is because of high prevalence of pulmonary tuberculosis, may be due to re-activation of disease when they get infected with HIV, not like as in Western Countries, were tuberculosis is an opportunistic infection in HIV positive patients.
G.N. Srivastava, None.