Lack of latent tuberculosis (TB) screening and delay in anti-retroviral therapy initiation in HIV-TB co-infection: an 11-year study in an intermediate TB-burden country

• Main Authors: Teng, Vannesa Yue May, Chua, Yan Ting, Lai, Eunice En Ni, Mukherjee, Shilpa, Michaels, Jessica, Wong, Chen Seong, Shen, Liang, Leo, Yee Sin, Young, Barnaby Edward, Archuleta, Sophia, Ong, Catherine W. M.
• Other Authors: Lee Kong Chian School of Medicine (LKCMedicine)
• Format: Article
• Language: English
• Published: 2022
• Subjects: Science::Medicine; Tuberculosis; HIV
• Online Access: https://hdl.handle.net/10356/153868
• Institution: Nanyang Technological University

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/mm(3). More patients with HIV diagnosed >= 6 weeks before TB (41%) were associated with CD4 counts > 200 cells/mm(3) 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/mm(3). Pulmonary TB patients with HIV can be infectious despite normal chest x-ray. Clinical practices can be further improved to benefit HIV-TB patients. (C) 2021 The Author(s). Published by Elsevier Ltd on behalf of International Society for Infectious Diseases.