An evaluation of the difference in the persentation and treatment response of Tuberculosis in HIV and TB sputum positive patients : Haart versus pre-Haart era

Abstract

Objective: The objective of this cross sectional study was to compare the clinical presentation and response to treatments, in HIV positive and TB smear positive patients treated during the pre-Highly Active Antiretroviral Therapy (HAART) and Highly Active Antiretroviral Therapy (HAART) era (2004 and 2007), in St Joseph’s hospital Roma Lesotho. Comparison was done in terms of age, sex, sputum conversion at 2months and 6months end of TB treatment, baseline and 6 months end of TB treatment weight, weight gained and radiological presentation and resolution. Method : It was a cross sectional study design. Data was captured from the TB/HIV register, for pre-HAART era data of patients registered in the 2004 TB/HIV was captured and for the HAART era data of patients registered in the 2007 TB/HIV was captured. Cases were individuals with sputum smear positive tuberculosis and confirmed HIV infection, presenting in the pre HAART era (2004) and in the HAART era (2007). For inclusion in the HAART era, an individual had to be on HAART for at least2 weeks or more. A total of 113 Patients were analysed and 85 patients the HAART era. Comparison of continuous measurements was done with a t-test and categorical measurement was done with a chi-square test. Multivariable logistic regression was used to detect differences between the pre-HAART and HAART era Result: One hundred and thirteen (113) patients were analysed in the pre-HAART era and eighty five (85) in the HAART era. Mean age of presentation was lower in the pre-HAART era 36.1 years compared to HAART era 39.3 years with statistically significant result (p=0.0362). Pattern of sex distribution was similar in both era, (p-value=0.85). Sputum conversion showed statistically significant differences at 2 months, 95.2% of the HAART patients had sputum reverted whereas, 83.2% of the pre-HAART had sputum reversion (p-value=0.009), but no statistically significant result was seen at 6 months (p-value=0.38). Weight did not differ significantly between the two time periods, but there was a statistically significant difference in terms of mean weight gained in Haart era. Patients in the HAART era gained 0.92kg at the end of treatment compared to pre HAART era (p-value=0.001). Radiological presentation and resolution did not differ significantly between the two time periods. (p-value= 0.36). Conclusion : Smear positive TB/HIV co-infected patients in the HAART era were older at presentation, had better sputum conversion at 2 months and improved weight gain at 6 months end of TB treatment. Comparison with a historical control group alone however does not conclusively prove that this effect is due to HAART. Copyright