Introduction
There are different types of prevention therapies used for managing and lowering the risk of TB and related diseases. The use of Isoniazid Prevention Therapy (IPT) helps normalize the health issues of patients with TB.1 The majority of patients who were suffering from these diseases are from low-income groups with poor education. They do not have adequate knowledge related to prevention and approaches that support to minimize the occurrence of TB using the ART treatment. There are several issues that are influencing the implementation of IPT. The lack of clinical treatment and issues of awareness are likely to account for a small fraction of reasons involve the lack of knowledge and proper diet as well as the side effects. 2 The government and medical professionals need to offer proper information about the issues and prevention methods of TB patients with HIV. The lack of support and wrong attitude of care workers towards such patients is having a significant impact on health and recovery. They are not having serious concerns with uncertainty and ruling out the impact of TB.
A study by World Health Organization (WHO) has provided information related to the symptoms based tuberculosis screening algorithm. 3 The lack of knowledge treatment and planning for offering of medicines is having a negative impact on the health condition of the patients and planning of the care professionals. The current study discusses the impact of TB on the health condition of HIV patients. Practically, the incident of screening and treatment is having a significant impact on a large population as it becomes difficult for the care professionals to reach every individual. Lack of education about the symptoms and prevention methods has resulted in increasing the level of infection among people. 4 The compliance of HIV services in implementing LTBI screening and treatment was often unsatisfactory. TB is one of the major causes of HIV and other infection based diseases and affects the health of the individual. For analyzing the health and providing better treatment to the people with such disease, the national and local government needs to increase the education and knowledge about such issues.
Aim
The study aims to determine the incidence of tuberculosis disease among patients with HIV while taking IPT and after its completion.
Materials and Methods
This is a retrospective, observational, longitudinal study that used existing records of patients from Department of Pulmonary Medicine, D Y Patil Medical College, Nerul, Navimumbai, Maharashtra, India. The period of the study was from January 2020 to June 2021. All government hospitals have been providing chronic HIV care (including ART) and IPT for eligible clients based on the national ART and TB/HIV guidelines since 2005. ART eligibility was based on the following criteria: all WHO stage IV clients, WHO stage III clients with CD4≤350 and WHO stage I or II with CD4≤ 200. In the absence of CD4 testing, all WHO stages III clients were eligible for ART. The first line ARV regimens used were according to national and international guidelines. STATA statistical software Version 12 was used to analyse the data. The sample size was estimated based on simple proportion formula taking incident TB disease after starting IPT 1.5% based on the study in a similar setting.
Results
Table 1
Baseline Demographic and Clinical Characteristics of Patients on IPT
According to Table 1, 960 patients were involved in the study and the mean age of the participants was 30 years range between 25-37 years. TB was developed in 9.2% patients, out of which, 2.2% of patients were diagnosed while receiving IPT and 6.97% after IPT. The incidence of TB was high among these patients in the last 4 months.
Table 2
Determinants of Occurrence of TB using isonizid preventive
As per Table 2, patients with higher baseline CD4 cell count (≥350 cells/mm3) and those receiving ART were less likely to develop TB disease (P<0.05). Other variables did not have an effect on the occurrence of incident TB disease among PLHIV who took IPT (P>0.05).
Table 3
Determinants of Occurrence of TB during and after IPT
As per Table 3, no evidence was identified for difference in risk factors and development of TB while taking IPT and after taking IPT (p>0.05).
Table 4
Final status
|
Last status |
Frequency |
Percentage |
Cumulative percentage |
|
Died |
46 |
4.7 |
2 |
|
Lost to follow-up |
100 |
10.4 |
10 |
|
Stopped treatment |
6 |
0.6 |
10 |
|
Transferred out |
278 |
28.9 |
18 |
|
Active |
530 |
55.2 |
100 |
Table 4 has shown the final analysis of the outcome of the patients after ART treatment 55.2% of patients were on this treatment at the last observation. Most of the patients (10.4%) with unfavourable follow-up outcomes were lost to follow-up. 0.6% of patients have stopped treatment during the follow-up and 28.9% were transferred out. However, 4.7% of patients have died and others were recovered. The unfavourable count of patients was 152 (15.8%).
Table 5
Unfavourable final status
As per Table 5, male was associated with increased hazard of having unfavourable final status (p<0.05)
Discussion
According to the analysis, the breakthrough TB was uncommon among those receiving IPT in the current study. According to the outcome of the current study, 960 patients were involved in the study and the mean age of the participants was 30 years range between 25-37 years. TB was developed in 9.2% patients, out of which, 2.2% of patients were diagnosed while receiving IPT and 6.97% after IPT. The incidence of TB was high among these patients in the last 4 months.5 The proper consideration of ART and CD4 cell count is helpful for planning and management of health issues of patients and better diagnose.6 As per the previous study, 3142 patients were considered for diagnosing and treatment and found that 27.1% were diagnosed with TB while receiving IPT and having critical issues.7
As per the study, 55.2% of patients were on this treatment at the last observation. Most of the patients (10.4%) with unfavourable follow-up outcomes were lost to follow-up. 0.6% of patients have stopped treatment during the follow-up and 28.9% was transferred out. However, 4.7% of patients have died and others were recovered. The unfavourable count of patients was 152 (15.8%). The previous study has shown that 64% were reported with negative effects of TB and HIV and 4% have died. Moreover, 28% were lost to follow-up and 4% were transferred. In this study, most patients also received ART and thus IPT adherence may have been better. 8 The compliance of HIV services in implementing LTBI screening and treatment was often unsatisfactory. TB is one of the major causes of HIV and other infection based diseases and affects the health of the individual. 9
Our results showed that HIV patients never tested for LTBI and those who tested positive at the first instance were at higher risk of TB disease development. 10
Conclusion
From the study, it has been carried out that breakthrough TB was uncommon and showing the significant proportion of it occurred in the first month of treatment and could be due to difficulty in diagnosing TB disease with HIV. The proper screening of patients is essential for offering treatment and providing effective care services. Moreover, the lack of education and awareness about the issues that could lead to serious illness are the major issues. The proper investigation and follow-up of such patients are important for preventing infection and maintaining good standards of health.
