Incidence of tuberculosis and mycobacteriosis among HIV-infected patients--clinical and epidemiological analysis of patients from north-eastern Poland.

INTRODUCTION

According to WHO data, among patients infected with HIV, tuberculosis occurs in about 30% of patients and causes approximately 25% of deaths due to AIDS worldwide. The incidence rate of tuberculosis in the Polish population was 22.2/100,000 in 2011, while the average in European Union countries in 2011 was 14/100,000. Since 1985 to 30 April 2013 HIV infection in Poland was confirmed in 16,588 patients, while the number of reported tuberculosis cases in HIV-infected individuals in 2011 was 26. The aim of this study was to assess the prevalence and clinical course of tuberculosis and mycobacterial disease in HIV-infected patients treated in the Department of Infectious Diseases and Hepatology in Białystok.

MATERIAL AND METHODS

We analysed documentation of 577 HIV-infected patients, their demographic data, epidemiological status, degree of immunosuppression (T CD4 and CD8 numbers) and stage of HIV infection.

RESULTS

Complete follow-up was possible in 389 patients, of whom 265 (68%) were male. Tuberculosis (TB) was diagnosed in 41 patients (10.5%) and mycobacteriosis in 4 patients (1.03%). In 19 patients (42%) HIV and TB or mycobacteriosis were diagnosed simultaneously. The median CD4 T lymphocyte count was lower in patients with a simultaneous diagnosis of HIV and tuberculosis or mycobacteriosis compared to the group in whom TB/mycobacteriosis was diagnosed later. The number of CD4 T-cells less than 50 cells/μL was found in 63.2% (12/19) of patients when HIV and TB or mycobacteriosis were diagnosed simultaneously and in 38.5% (10/26) of patients who were diagnosed with TB or mycobacteriosis later than the HIV infection (p = 0.14). The median HIV viral load in patients in whom HIV infection and tuberculosis or mycobacteriosis were diagnosed at the same time was higher than in other patients and this difference was statistically significant. Pulmonary tuberculosis was the most common form of clinical disease and accounted for 60% of all cases. Among the analysed cases with HIV and tuberculosis or mycobacteriosis coinfection, tuberculosis or mycobacteriosis was the cause of death in 8 patients, and 9 died of other causes.

CONCLUSION

In our material of 389 HIV-infected patients, tuberculosis was diagnosed in 41 (10.5%) and mycobacterial diseases in 4 (1.03%). In 42% of co-infected patients (HIV+TB or mycobacteriosis) the diagnosis of both diseases was made at the same time. In these patients, a deep deficit of cellular immunity (CD4 < 50 cells/μL) was observed more frequently than in patients diagnosed with TB or mycobacteriosis in the later course of HIV. HIV RNA viral load was significantly higher in the group diagnosed simultaneously than in the remaining patients with HIV and TB or mycobacteriosis coinfection.