Abstract:
Background: Co-infection with tuberculosis and human immunodeficiency virus (TB-HIV) remains a major global
health problem, with about 1.1 million new cases of TB in HIV-positive persons reported in 2011; 79% of the reported
cases were amongst patients living in Africa. Advanced immune suppression remains the most important risk factor
for tuberculosis in those with HIV, but epidemiological and clinical factors have also been identified. We sought to
determine the prevalence and factors associated with pulmonary tuberculosis (PTB) in antiretroviral therapy (ART)-
naive HIV-infected patients seeking HIV care services at a tertiary health facility in North Central Nigeria.
Methods: We compared clinical and laboratory data for 218 HIV-1 positive adults with and without a diagnosis of
pulmonary tuberculosis. Results from univariate analyses informed the selection of predictors to conduct multivariate
analysis to determine which factors were associated with presence of PTB-HIV co-infection.
Results: The prevalence of PTB-HIV co-infection in the evaluated cohort was 9.6%. Lower CD4+ cell count
and the presence of oropharyngeal candidiasis were independently associated with PTB-HIV co-infection. CD4+
cell count was strongly associated with PTB-HIV co-infection (p=0.002) with the odds of co-infection reduced by
85% in those with a CD4+ cell count >100 cells/mm3 compared to those with <100 cells/ mm3. There was a strong
association between oropharyngeal candidiasis and PTB-HIV co-infection, where the odds of co-infection are about
4.5 times higher in those with oropharyngeal candidiasis than those without candidiasis (p=0.008).
Conclusion: PTB was prevalent among HIV patients seeking care in our setting. Severe immune suppression
and oropharyngeal candidiasis were associated with PTB-HIV co-infection in our patients at presentation. Potential
implications for severe immune suppression and advanced HIV disease are a poor clinical outcome and further
spread of PTB. Strategies to encourage the early diagnosis of both HIV and TB should be considered
