Lack of latent tuberculosis (TB) screening and delay in anti-retroviral therapy initiation in HIV-TB co-infection: an 11-year study in an intermediate TB-burden country. (December 2021)

• Record Type: Journal Article
• Authors: Teng, Vannesa Yue May; Chua, Yan Ting; Lai, Eunice En Ni; Mukherjee, Shilpa; Michaels, Jessica; Wong, Chen Seong; Shen, Liang; Leo, Yee Sin; Young, Barnaby; Archuleta, Sophia; Ong, Catherine W.M.
• Is Part Of: International journal of infectious diseases. Volume 113(2021)
• Page Start: 178
• Page End: 183
• Publication Date: 2021-12
• Subjects: Tuberculosis -- HIV -- latent tuberculosis infection; Communicable diseases -- Periodicals; Communicable Diseases -- Periodicals; Communicable diseases; Periodicals; Electronic journals; 616.9
• DOI: 10.1016/j.ijid.2021.09.048
• Languages: English
• ISSNs: 1201-9712

Abstract

Highlights: Latent tuberculosis (TB) screening in HIV patients is suboptimal in Singapore Initiation of antiretroviral therapy was delayed in HIV-TB patients in Singapore There is a window of opportunity to reduce the prevalence of HIV-TB co-infection Abstract: Objectives: To examine the prevalence and characteristics of HIV-tuberculosis (TB) co-infected patients in Singapore, an intermediate TB-burden country. Methods: Retrospective data across 11 years was obtained from the National University Hospital (NUH), a quaternary hospital and the National Centre for Infectious Diseases (NCID), the national HIV center. Results: From December 2005 to December 2016, 4015 HIV-infected patients were managed at NUH and NCID, of whom, respectively, 48 and 272 were diagnosed with active TB disease. Only 2 patients (0.6%) were screened for latent TB infection on HIV diagnosis. Mean CD4 count at TB diagnosis was 125.0 ± 153.9 cells/mm 3 . More patients with HIV diagnosed ≥6 weeks before TB (41%) were associated with CD4 counts >200 cells/mm 3 than patients with TB diagnosed ≥6 weeks before HIV (2%). Of 124 (38.6%) HIV-TB patients with CD4 count ≤50 cells/mm 3, only 18 (14.2%) started anti-retroviral therapy (ART) in <2 weeks. Of patients with pulmonary TB, 33.5% had normal chest x-ray. Conclusions: Latent TB infection screening in HIV-infected patients is low, and ART initiation is delayed in HIV-TB patients with CD4 ≤50 cells/mm 3 . Pulmonary TB patients with HIV can be infectious despite normal chest x-ray. Clinical practices can be further improved to benefit HIV-TB patients.