Vannesa Yue May Teng1, Yan Ting Chua2, Eunice En Ni Lai2, Shilpa Mukherjee2, Jessica Michaels2, Chen Seong Wong3, Liang Shen4, Yee Sin Leo5, Barnaby Young5, Sophia Archuleta6, Catherine W M Ong7. 1. Department of Medicine, National University Hospital, National University Health System Singapore. Electronic address: vannesa_teng@nuhs.edu.sg. 2. Department of Medicine, National University Hospital, National University Health System Singapore. 3. National Centre for Infectious Disease, Singapore; Department of Infectious Disease, Tan Tock Seng Hospital, Singapore. 4. Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore. 5. National Centre for Infectious Disease, Singapore; Department of Infectious Disease, Tan Tock Seng Hospital, Singapore; Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore. 6. Department of Medicine, National University Hospital, National University Health System Singapore; Infectious Disease Translational Research Programme, Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore. 7. Department of Medicine, National University Hospital, National University Health System Singapore; Infectious Disease Translational Research Programme, Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore; Institute for Health Innovation & Technology, National University of Singapore. Electronic address: catherine_wm_ong@nuhs.edu.sg.
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/mm3. More patients with HIV diagnosed ≥6 weeks before TB (41%) were associated with CD4 counts >200 cells/mm3 than patients with TB diagnosed ≥6 weeks before HIV (2%). Of 124 (38.6%) HIV-TB patients with CD4 count ≤50 cells/mm3, 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/mm3. Pulmonary TB patients with HIV can be infectious despite normal chest x-ray. Clinical practices can be further improved to benefit HIV-TB patients.
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/mm3. More patients with HIV diagnosed ≥6 weeks before TB (41%) were associated with CD4 counts >200 cells/mm3 than patients with TB diagnosed ≥6 weeks before HIV (2%). Of 124 (38.6%) HIV-TB patients with CD4 count ≤50 cells/mm3, 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/mm3. Pulmonary TB patients with HIV can be infectious despite normal chest x-ray. Clinical practices can be further improved to benefit HIV-TB patients.
Authors: G B Migliori; S J Wu; A Matteelli; D Zenner; D Goletti; S Ahmedov; S Al-Abri; D M Allen; M E Balcells; A L Garcia-Basteiro; E Cambau; R E Chaisson; C B E Chee; M P Dalcolmo; J T Denholm; C Erkens; S Esposito; P Farnia; J S Friedland; S Graham; Y Hamada; A D Harries; A W Kay; A Kritski; S Manga; B J Marais; D Menzies; D Ng; L Petrone; A Rendon; D R Silva; H S Schaaf; A Skrahina; G Sotgiu; G Thwaites; S Tiberi; N Tukvadze; J-P Zellweger; L D Ambrosio; R Centis; C W M Ong Journal: Int J Tuberc Lung Dis Date: 2022-03-01 Impact factor: 3.427