Epidemological Association of Tuberculosis and HIV in Visakhapatnam District 1

The object of our study is to observe the epidemiological distribution and association of Tuberculosis (TB) co-infection with HIV among the Visakhapatnam zone of Andhrapradesh. It is mainly due to Tuberculosis and HIV has been closely linked and HIV infection has contributed to a significant increase in the worldwide incidence of tuberculosis. According to WHO, the proportion of TB cases co-infected with HIV was also found rising being 210 times greater for 1997 estimates than for 1990. By producing a progressive decline in cell-mediated immunity, HIV alters the pathogenesis of tuberculosis, greatly increasing the risk of developing disease in co-infected individuals and leading to more frequent extra pulmonary involvement and atypical radiographic manifestations. In the present analysis it was found that in new smear pulmonary TB cases; there was an increase trend in number of cases in both male and female. According to smear positive and smear negative TB cases, male are more prone to TB (71.77% smear positive and 63.83% smear negative) than female (28.22% smear positive and 36.16% smear negative). In all the TB cases registered through RNTCP 4186 TB Patients are reported to be tested for HIV before or during the treatment. Out of those 4,186 cases, 558 are HIV positive.


INTRODUCTION
Tuberculosis (TB) remains number one killer infectious disease affecting adults in developing countries developing countries.India is a home for 3.4 million TB patients which accounts for 1/5 th of the global figure.The proportion of TB cases co-infected with HIV was also found rising being 2-10 times greater for 1997 estimates (Chakraborty, 2004;Dye et al., 1999).
India had a National Tuberculosis Program (NTPC) since 1960's.In spite of that there were serious limitations in the diagnostic paradigm and treatment regimens.In 1993; the NTP program in INDIA was strengthened in form of Revised National Tuberculosis Program (RNTCP) Wikipedia encyclopedia.TB situation in an area is measured in terms of: • Death, among the known cases of TB • Prevalence and incidence of infection • Person's diseases at a point of time in given community The importance of tuberculosis to global HIV epidemic is enormous.TB is leading cause of HIV related deaths worldwide.In 2008, there were an estimated 1.4 million new cases of TB which accounted for 23% of AIDS related death.The risk of tuberculosis among HIV infections is closely related with number of CD 4+ lymphocytes, as it was shown in study among HIV infected person with tuberculin skin test reaction of 5 mm in Italy (Antonnucci et al., 1995).
Keeping these studies in mind we undertook this study to find the epidemiological and clinical features of TB patients in Visakhapatnam district.

MATERIALS AND METHODS
The epidemiological survey design provided with TB testing of Visakhapatnam district of year 2009, with lineage to demographic clinical data of these cases.The data was collected from district TB control office from Visakhapatnam TB hospital.The survey was undertaken in order to determine the impact of HIV on present TB cases in Visakhapatnam district.Diagnosis of TB is based on sputum smear microscopy and chest radiography.

Staining technique:
In this Technique two sputum samples are collected over two days (as spot morning) from chest symptomatic and when stained with Zeihl Nelseen stain, the acid fast bacilli stained bright red and stand out clearly against a blue background.This test specify 99% test sensitivity.
In situation where the two smears are negative then chest and X-ray is being performed.
Chest radiography: It is a regularly performed investigation.Diffused Pulmonary infiltrates is the dominant radiological presentation.In presence of radiographic lesion suggest of TB with negative sputum smears in a patients.

RESULTS AND DISCUSSION
A total no. of 4,996 TB cases were reported through RNTCP statistics in Visakhapatnam district during the year 2009 (data collected from district TB office).The number of TB patients as per present study is 15 years age are more, where as within 14 years, it is less reported (Table 1).Low prevalence in children below 14 years may be due to BCG vaccination as it provides protection against childhood TB.These observations can be related with that of NFHS-2 (13.73/1000 in 60 years and 1.53/1000 in 0-14 years and survey carried out in urban population of Delhi (highest prevalence in the +55 age group (11.98%) (Study of Epidemiology of TB in Urban Population of Delhi, 1999;National Family Health Survey-2 India, 1998-1999).In new smear pulmonary TB cases; there is increase trend in number of cases in both male and female.Highest percentage was reported in male in age group 35-44 (24.78%) and in female in age group of 25-34 (22.80%).In further age group there is decrease in TB patients in both genders and age.
In all the TB cases registered through RNTCP 4186 TB patients are reported to be tested for HIV before or during the treatment.Out of those 4,186 cases, 558 are HIV positive (Table 3).A study in Andhra Pradesh showed that a third of TB patients treated by private medical practitioners had coinfections of TB and HIV (Jain et al., 1996).A similar study conducted by Dakshina Kannada district of Karnataka revealed out of 250 TB cases 25 cases (10%) were HIV positive (Acharya and Majra, 2007).Sero prevalence of HIV among TB patients in a study conducted in Jammu and Kashmir was 1.6% (Bahl et al., 2007) .

Table 1 :
Age wise new smear TB cases