Introduction

Tuberculosis (TB) has existed in humans since antiquity and has been reported as the most common expressive and infective respiratory disease that results from the inhalation of air droplets infected with tubercle Mycobacterium tuberculosis. ¹ An estimated 1/3 of the world’s population is infected with the bacterium, with the highest prevalence of the disease found in sub-Saharan Africa and Asia.^2,1 More than half of these live in countries ravaged by HIV/ AIDS.³ However , Nigeria has been noted as among the leading countries burdened by the scourge and even ranks 4^th among the 22 countries that account for 80% of the world’s TB cases.⁴

The emergence of Human Immunodeficiency Virus (HIV) has paved way for the resurgence of Mycobacterium tuberculosis infection. While HIV is the most powerful risk factor for the progression of M tuberculosis infection to TB disease, TB accelerates the progression of HIV infection to AIDS and shortens the survival of such patients.^5,6 The two are intricately linked to malnutrition, unemployment, poverty, drug abuse and alcoholism and have also been referred to as the ‘Cursed Duet’.³ HIV is known to increase the risk of reactivation in people with latent tuberculosis and also increases the risk of subsequent episodes of TB from exogenous reinfection.^3,7 It has also corroborated by noting that HIV patients are highly vulnerable to TB because of their weakened immune systems and the latter is now their number one killer.² Surveillance of HIV among TB patients has been recognised as important as the HIV epidemic continues to fuel TB epidemics. In many countries, HIV prevalence among TB patients is a sensitive indicator of the spread of HIV into the general population.⁸

In the view of the aforementioned, this study became imperative in this area with a reported HIV prevalence of 38.65%¹⁷ in order to provide baseline data in Nasarawa State to alert the TB and HIV/ AIDS programs of the potential HIV problems leading to the development of joint strategies.

Materials and Methods

Study Area

Study Population

Human Immunodeficiency Virus Detection

Principle of the Test

Test Procedure

Interpretation of Results

Statistical Analysis

Results

The study population was made of 257 confirmed Tuberculosis Patients screened for HIV. Of these, 116(45%) were females while 141 (55%) were males. There were more patients in the 21-40 years age group (62%) than in any other age group. Patients above 60 years old were the least (30%).

The overall prevalence of coinfection of M. tuberculosis and HIV in this population was 41.2%. In relation to gender, it was 44.8% amd 38.3% among females and males respectively (Table1).

Figure 1

Table 1. Prevalence of HIV infection among Tuberculosis Patients in relation to gender

There was a statistically significant relationship between gender and viral infection (p<0.05). The prevalence of coinfection also varied with age of the patients. It was highest among TB patients aged 21-40 years (45.3%) followed by those aged 41-60 years (36.8%), 1-20 years (34%) and least among those aged above 60 years (25.00%) (Table 2).

Figure 2

Table 2. Prevalence of HIV infection among Tuberculosis Patients in Relation to Age

There was a statistically significant association between age and HIV infection among TB patients in this study (p<0.05).

Discussion

The HIV prevalence of 41.2% among TB patients of the TB/Leprosy hospital is the highest that has been reported for such studies in Nigeria. This is a cause for alarm especially in view of the fact that HIV prevalence among TB patients is a good indicator of the spread of HIV in the general population. This high prevalence might not be unconnected with the relatively high HIV prevalence in the area ¹⁷ which is important in latent TB reactivation ³ leading to a preponderance of HIV/TB coinfection. Reports of similar studies in Nigeria ranged from 12.0% in Ile-Ife ⁹ 10.0% in Kano ¹⁰, 10.5% and 14.9% among children and adults respectively in Sagamu ^11,12, 10.8% in Irrua ¹³, 6.1% among those aged 20-40 years in Jos, ¹⁴ 37.5% in Benin City, ¹⁵ 4.2% in Oyo and 35.1% in Benue States.¹⁶ Results from this study are however similar to that of a study in Tanzania where 44.1% was reported ¹⁸ although it is higher when compared with reports from other parts of the globe. For example, 0.4-20.1% was reported from India ^{3, 19}, 30.0% in Trinidad and Tobago ²⁰, 28.2% in Guyana ²¹, and 9.9% in Cambodia. ²²

There was a significantly higher prevalence of HIV/TB coinfection (p<0.05) among females than males. This is probably related to the higher incidence of HIV infection in females which predisposed them to TB as the former is known to activate dormant TB. Women also have a higher susceptibility to HIV infection and are usually exposed to sexual activities earlier than men mainly due to economic circumstances. Furthermore, most African women are so subordinated to their husbands that they have little or no say in issues related to sexual relationships .¹³ The study was in an area where polygamy and early marriage thrive . It is therefore possible for one male to be the source of infection to several females.

The preponderance of HIV/TB coinfection among patients aged 21-40 years observed in this study (p<0.05) is similar to some other reports.^14,5,16,22 This is a sexually active group in which both TB and HIV prevail most.¹⁷ Thus the significantly high prevalence of coinfection.

Conclusion

The high HIV seroprevalence in this TB patient population is of great concern both in terms of patient management and public health prospective. It also underscores the need for routine HIV serology on all TB patients to avoid adverse drug reactions to antituberculosis drugs. There is also a need to develop aggressive public awareness, good health education and provide routine HIV screening for TB patients.

Acknowledgement