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 Table of Contents  
ORIGINAL ARTICLE
Year : 2014  |  Volume : 2  |  Issue : 2  |  Page : 90-94

Prevalence of HIV infection among patients with pulmonary tuberculosis in a rural tertiary hospital in Nigeria


1 Department of Medical Microbiology, College of Health Sciences, Igbinedion University, Okada, Edo, Nigeria
2 Department of Pathology, Igbinedion University Teaching Hospital, Okada, Edo, Nigeria
3 Department of Microbiology, Faculty of Natural Sciences, Igbinedion University Okada, Edo, Nigeria
4 Immunology Unit, College of Medicine, University of Ibadan, Ibadan, Nigeria; Faculty of Health and Social Care Sciences, St George's University of London and Kingston University, London

Date of Web Publication17-Nov-2014

Correspondence Address:
Bankole Henry Oladeinde
Department of Medical Microbiology, College of Health Sciences, Igbinedion University, Okada, Edo, Nigeria

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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2348-0149.144843

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  Abstract 

Background: Human Immunodeficiency Virus (HIV) infection, increases morbidity and mortality among pulmonary tuberculosis (PTB) patients. Data are lacking on the prevalence of HIV among TB patients in rural communities of Edo State, Nigeria. Aim: This study aimed at determining the prevalence and associated risk factors of HIV infection among patients with PTB from 2006-2011 at rural tertiary hospital in Nigeria. Materials and Methods: Venous blood obtained from a total of 250 patients with newly diagnosed cases of PTB was tested for the presence of HIV antibodies using standard technique. A structured questionnaire was used to obtain demographic information. This was a laboratory based cross-sectional study. Results: The overall prevalence of HIV infection among study subjects was 32.8%. Although the prevalence of HIV infection was observed to drop from 36.5% in 2006 to 29. 2% in 2011, the difference was not statistically significant (P = 0.98). Gender was not a risk factor for HIV-PTB co-infection [female vs. male: 37.3% (53/142) vs. 26.8% (29/108); P = 0.10, OR = 1.622; 95% CI = 0.941, 2.797]. Age was identified as a risk factor for HIV-PTB co-infection (P < 0.0001), with participants within the age group of 21-30 years having the highest risk. The prevalence of HIV-TB co-infection was not significantly affected by educational status (P = 0.48), occupation (P = 0.19) and marital status (P = 0.23) of study participants. Conclusion: The overall prevalence of HIV infection among patients with PTB was 32.8%. Age was a significant risk factor for HIV-PTB co-infection. Increased surveillance of HIV-PTB co-infection in rural communities of Nigeria is advocated.

Keywords: HIV infection, nigeria, pulmonary tuberculosis, rural community


How to cite this article:
Oladeinde BH, Olley M, Imade OS, Onifade AA. Prevalence of HIV infection among patients with pulmonary tuberculosis in a rural tertiary hospital in Nigeria . Niger J Exp Clin Biosci 2014;2:90-4

How to cite this URL:
Oladeinde BH, Olley M, Imade OS, Onifade AA. Prevalence of HIV infection among patients with pulmonary tuberculosis in a rural tertiary hospital in Nigeria . Niger J Exp Clin Biosci [serial online] 2014 [cited 2021 May 12];2:90-4. Available from: https://www.njecbonline.org/text.asp?2014/2/2/90/144843


  Introduction Top


Tuberculosis (TB) and HIV/AIDS are two worldwide public health concerns. [1] Co-infection of these two diseases has been considered to be a major obstacle for the global efforts in reaching the goals for the prevention of HIV and TB infections. [1] HIV infection is a risk factor predisposing to Mycobacterium tuberculosis infection and progression to active disease. [2] Findings from some studies indicate that people living with HIV have a higher risk of developing multi-drug resistant tuberculosis (MDR-TB) which is associated with increased mortality. [3] Mycobacterium tuberculosis and HIV act in synergy, accelerating the decline of immunological functions and leading to subsequent death of patient if untreated. [2]

Mycobacterium tuberculosis and Human Immunodeficiency Virus (HIV) co-infection is reported as the world's leading cause of death due to infectious agents. [4],[5] Globally, its prevalence shows marked variation from one region to another. Africa accounts for about 70% of the global burden of co-infection with TB and HIV, with a vast number of persons so infected resident in sub-Saharan African countries. [6] To mitigate the dual burden of TB/HIV in populations at risk of or affected by both diseases, the World Health Organization (WHO) recommended universal HIV testing for all newly diagnosed TB cases and TB assessment of all newly diagnosed HIV cases. [7] Despite these recommendations, evidence suggests that universal testing for HIV among new TB cases has not been achieved. [8]

The prevalence of HIV and TB co-infection has been reported to be linked with poverty and poor nutrition, [9] factors which are rife in many rural communities in Nigeria. [10] Although studies on prevalence of HIV among patients with TB exists in Nigeria, few have focused on persons living in rural communities where factors hitherto identified as driving forces for HIV-TB co-infections [11] are rife. [10] Indeed no study has focused on rural population in Edo State, Nigeria. Limited knowledge about the prevalence of HIV infection among TB patients compromises the planning, and resource allocation to prevention and control activities. [12] Against this background, this study aimed at determining the prevalence and associated risk factors of HIV infection among patients with pulmonary tuberculosis (PTB) within a 6 years period at rural tertiary hospital in Nigeria.


  Materials and methods Top


Study Area

Okada, a rural community is the headquarters of Ovia North East Local Government Area of Edo State. The Local Government has an estimated population of 155, 344 persons. [13] Majority of the residents of the community are farmers with few Civil Servants, Lecturers, and students making less than 5% of the community. The study was conducted at the Igbinedion University teaching hospital Okada, from February 2006-December 2011. Some neighboring rural communities (villages) also attend the hospital.

Study Population

A total of 250 patients with newly diagnosed cases of PTB at the chest clinic of the Igbinedion University Teaching Hospital Okada were recruited for this study. PTB was diagnosed by smear microscopy of sputum using the Ziehl Nelson method for the detection of Acid and Alcohol Fast Bacilli. [14],[15] Age-range of volunteer patients was 11-69 years and they consisted of 108 males and 142 females. The purpose of the research was carefully explained to all participants. Pre-HIV testing counseling was given to all consenting patients. Informed consent was obtained from all subjects prior to specimen collection. In the case of minors, consent was obtained from their parents or guardians. A questionnaire was used to obtained relevant information from study participants. The ethical committee of Igbinedion University Teaching Hospital approved the protocol for this study. This was a laboratory based cross sectional study.

Specimen Collection and Processing

5 ml of venous blood was collected from all PTB smear positive patients, and placed in a plain container to clot. The serum obtained was used for the serological diagnosis of HIV using a previously described method. [16] Briefly, each patient's serum was screened for the presence of HIV antibodies using Determine (Abbott Laboratories, Tokyo, Japan) and HIV 1/2 Stat-Pak (Chembio Diagnostic Systems, New York, NY, USA). When both kits showed positivity, the patient was regarded as positive for HIV infection and vice versa. However, when test results were discordant, a third kit Genie II HIV-1/HIV-2 (Biorad, Marne-la-Coquette, France) was used. The HIV sero-status of the patient was taken as the result of either of the first two kits that agree with that of the third kit.

Statistical Analysis

The data obtained were analyzed using Chi-Square (X 2 ) test and odd ratio analysis using the statistical software INSTAT® (Graphpad software Inc., La Jolla, CA, USA). Statistical significance was set at P < 0.05.


  Results Top


The prevalence of HIV infection among study participants was 32.8%. Although the prevalence was observed to drop from 36.5% in 2006 to 29. 2% in 2011, the difference was not statistically significant (P = 0.98). A total of 79 (96.3%) of the 82 patients infected with HIV tested positive to HIV I antibodies only [Table 1].
Table 1: Prevalence of HIV infection among patients with pulmonary tuberculosis

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An association was observed to exist between HIV infection and female gender (female vs. male: 37.3 vs.26.8; OR = 1.622, 95% CI = 0.941, 2.797). Gender however was not a risk factor for acquisition of HIV infection in this study (P = 0.100). Age was identified as a risk factor (P < 0.001) for acquiring HIV among study participants with those within the age group of 21-30 years having the highest risk. The prevalence of HIV infection was not significantly affected by educational status (P = 0.48), occupation (P = 0.19) and marital status (P = 0.23) of study participants [Table 2].
Table 2: Effect of gender, age, occupation, educational and marital status on prevalence of HIV infection

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  Discussion Top


Collaboration between TB and HIV/AIDS programs provides the needed support to health care providers in delivering the full range of HIV and TB prevention and care interventions. Against this background this study aimed at determining the prevalence of HIV among patients with PTB in a rural tertiary hospital in Nigeria within a 6 year period.

The overall prevalence of HIV infection among patients with PTB was 32.8%. This is higher than reported values in a number of Nigerian studies. [17],[18],[19] The variation could be due to differences in location of study population, as the prevalence of HIV infection has been reported to have geographical variation in several other African studies. [20],[21],[22] In a generalized HIV epidemic, the rate of HIV infection among TB patients has been reported as an indicator of the maturity of the HIV epidemic and predicts the occurrence of new TB cases at country level. [12] High prevalence of HIV infection (10.2%) has previously been reported among pregnant women receiving ante-natal care in same health facility as the one used in this present study. [10] This may explain the high prevalence of HIV infection observed in this study. HIV-1 was the most predominant HIV subtype recorded in this study. This has been documented in an earlier Nigerian Study. [23] Although the prevalence of HIV infection among study participants was observed to drop from 36.5% in 2006 to 29. 2% in 2011, the difference was not statistically significant. The prevalence of TB in sub-Saharan Africa is largely driven by the HIV pandemic. [24] Reports show that HIV infection in Africa is associated with urban-rural and intra-rural human mobility. [25],[26] Okada community plays host to the Igbinedion University, Nigeria premier private University. Over the years there has been an influx of skilled and unskilled labor into the community. These persons may have consistently served as vehicles of importing HIV/AIDS into the community, resulting in the generally high prevalence of HIV infection observed over the years of study.

A higher prevalence of HIV infection was observed among female participants in this study. This has been previously documented. [27] Factors such as poverty, sexual violence against women, and cultural limitation that promotes intergenerational sex previously reported to increase risk of acquiring HIV among African women [28] , may be responsible for this observation. Age was found to be a significant risk factor for acquiring HIV infection among study subjects. This is consistent with findings from a Nigerian study. [29] Patients within the age group of 21-30 years were observed to bear the highest risk of infection with HIV. Persons within this age category have been reported to exhibit risky sexual behavior for HIV infection in a previous African study. [30] This may explain the observed high frequency of HIV infection among this class of patients. The prevalence of HIV infection was not significantly affected by educational status of study participants. This is in contrast to findings from an earlier study. [31]

In this study, traders were observed to have the highest prevalence of HIV-TB co-infection, albeit occupation did not significantly affect the prevalence of HIV infection. An important element of the process of trading is mobility. Commercial activities among rural dwellers are mostly carried through periodic markets which often require the movement of persons from one community to another to buy and sell. Reports have associated mobility of person's to high HIV prevalence. [32] Several aspects of mobility, such as opportunities to participate in transactional sex, isolation from communities of home and origin, and the desire for unique experiences, all enhance the likelihood of casual sexual experiences while at the migration destinations. [33] The loss of sexual inhibition to casual sex as a result of being in distant places due to mobility may account for the observed higher frequency of HIV infection among traders in this study. Study participants who were married were observed to have a higher prevalence of HIV infection. This is consistent with an earlier report. [32]

Several studies have shown that the immediate use of highly active antiretroviral therapy (HAART) is associated with marked reduction in HIV transmission in sero-discordant couples. [34],[35],[36] Access to information and health services is much poorer in rural settlement than cities and rural dwellers are less likely to be informed with protective measures against HIV infection. [10] HAART service points are virtually absent in our study area. Consequently, HIV infected patients in the locality may not be candidates for prompt initiation of HAART, thus representing high risk for transmission of the virus to others and ultimately increasing the number of new HIV cases in the community. Obviously for fear of turning out positive to HIV when screened, many of the patients with newly diagnosed cases of PTB declined to participate in this study, resulting in the small number of patients enrolled for this work. This is an observed limitation to this study.

In summary, the overall prevalence of HIV infection among patients with PTB was 32.2%. Although the prevalence of HIV infection among study participants was observed to decline from 36.5% in 2006 to 29.2% in 2011, the difference was not statistically significant. HIV infection was significantly affected by age of study participants. Access to information and health services is much poorer in rural settlement than cities in Nigeria. A large number of patients with newly diagnosed PTB declined to participate in this study. This is critical to the success of HIV/TB integrated interventions. There is need for promoting universal HIV testing among patients with PTB especially in rural areas. This can be facilitated by the provision of free HIV testing centers and scaling up of HIV prevention and enlightenment campaign by relevant government and intervention agencies among rural dwellers in Nigeria.


  Acknowledgement Top


Authors acknowledge with thanks all patients who participated in the study.

 
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