A comparative study of mycobacterium tuberculosis infection in Hospitalised adult HIV infected patients with normal and abnormal renal function at the University Teaching Hospital,Lusaka
Date
2016
Authors
Namakando, Liusha
Journal Title
Journal ISSN
Volume Title
Publisher
The University of Zambia
Abstract
Background
Tuberculosis (TB) remains a leading cause of mortality and morbidity worldwide, including
Zambia, especially among the HIV infected. Both renal dysfunction and tuberculosis have been
shown to be highly prevalent among hospitalised HIV infected patients.
Little is known about how TB and renal dysfunction impact each other, and whether there is
any association between the occurrence of renal dysfunction and active TB infection in the HIV
infected population.
General Objective
To determine the prevalence and determinants of active TB infection in HIV infected patients
with and without kidney dysfunction.
Specific Objectives
To compare the proportion of active TB and identify its determinants among HIV infected
patients with and without kidney dysfunction; and establish its association with kidney disease
(and its severity).
Methodology
This was a cross – sectional, analytical study. Calculated sample size was 126 using Open
EpiTM (2013). Using simple random sampling, HIV positive patients on the medical wards were
recruited in two arms (with & without kidney dysfunction). Data and specimen were collected
by the principle investigator and sent for analysis to respective laboratories. Data was entered
onto a Microsoft office excel spread sheet, and analysed using STATA version 13.
Results and Discussion
A total of 133 patients (74 with renal dysfunction and 59 with normal renal function) were
analysed. Microbiological TB prevalence in all HIV positive hospitalised patients was 24%,
and 45% when radiological diagnosis was added. Mycobacterium tuberculosis was more
prevalent in the kidney disease group at 54% compared to the non-kidney disease group at
35.59% (p=0.034). Patients in WHO stage III/IV were likely to present with TB in both groups
(P=0.004, 95% CI 1.47 - 7.20).
Among kidney disease patients; a higher CD4 count > 200cells/μl appears to be protective for
active TB (P = 0.011, OR 0.19, 95% CI 0.05 – 0.69). Severe immunosuppression (CD4 count
< 200 cells/μl) was 18.64% higher in this group (P=0.026). While, active TB was associated
with evening fever (OR 2.44, 95% CI 1.00 – 5.95, P = 0.049) and male gender (OR 4.57, 95%
CI 1.17 - 17.82, P = 0.029). On the other hand; renal dysfunction severity as measured by eGFR
(P = 0.379); age, ART status and duration on cART, as well as history of TB contact and current
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cough, had no significant association with active TB in the kidney disease group; while
Proteinuria in a TB patient was strongly associated with renal dysfunction (P < 0.001).
Conclusion
Patients with kidney disease are more likely to present with activeMycobacterium tuberculosis
infection than other HIV infected patients. Among patients with active TB, urinalysis can help
predict renal dysfunction; while determinants of active TB in the general population are not
similar to those in kidney disease patients.
Description
Keywords
Tuberculosis-Lusaka, Zambia , AIDS(Disease)-Complications-Lusaka, Zambia