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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Prevalence of Pulmonary Tuberculosis Among HIV Positive Patients Attending Antiretroviral Therapy Clinic</title><author><name sortKey="Giri, Purushottam A" sort="Giri, Purushottam A" uniqKey="Giri P" first="Purushottam A" last="Giri">Purushottam A. Giri</name><affiliation><nlm:aff id="aff1"></nlm:aff></affiliation></author><author><name sortKey="Deshpande, Jayant D" sort="Deshpande, Jayant D" uniqKey="Deshpande J" first="Jayant D" last="Deshpande">Jayant D. Deshpande</name><affiliation><nlm:aff id="aff1"></nlm:aff></affiliation></author><author><name sortKey="Phalke, Deepak B" sort="Phalke, Deepak B" uniqKey="Phalke D" first="Deepak B" last="Phalke">Deepak B. Phalke</name><affiliation><nlm:aff id="aff1"></nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">23923111</idno><idno type="pmc">3731868</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3731868</idno><idno type="RBID">PMC:3731868</idno><idno type="doi">10.4103/1947-2714.114169</idno><date when="2013">2013</date><idno type="wicri:Area/Pmc/Corpus">002794</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">002794</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Prevalence of Pulmonary Tuberculosis Among HIV Positive Patients Attending Antiretroviral Therapy Clinic</title><author><name sortKey="Giri, Purushottam A" sort="Giri, Purushottam A" uniqKey="Giri P" first="Purushottam A" last="Giri">Purushottam A. Giri</name><affiliation><nlm:aff id="aff1"></nlm:aff></affiliation></author><author><name sortKey="Deshpande, Jayant D" sort="Deshpande, Jayant D" uniqKey="Deshpande J" first="Jayant D" last="Deshpande">Jayant D. Deshpande</name><affiliation><nlm:aff id="aff1"></nlm:aff></affiliation></author><author><name sortKey="Phalke, Deepak B" sort="Phalke, Deepak B" uniqKey="Phalke D" first="Deepak B" last="Phalke">Deepak B. Phalke</name><affiliation><nlm:aff id="aff1"></nlm:aff></affiliation></author></analytic><series><title level="j">North American Journal of Medical Sciences</title><idno type="ISSN">2250-1541</idno><idno type="eISSN">1947-2714</idno><imprint><date when="2013">2013</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec id="st1"><title>Background:</title><p>Tuberculosis (TB) is the most common serious opportunistic infection in HIV positive patients and is the manifestation of AIDS in more than 50% of cases in developing countries. TB can occur at any time during the course of HIV infection.</p></sec><sec id="st2"><title>Aim:</title><p>To describe the socio-demographic profile and prevalence of pulmonary tuberculosis (HIV/TB co-infection) among HIV positive patients been attended at the antiretroviral therapy clinic (ART) clinic at tertiary care teaching hospital of western Maharashtra, India.</p></sec><sec id="st3"><title>Materials and Methods:</title><p>A cross-sectional study was carried out at the ART clinic of Pravara Rural Hospital, Loni, from June 2011 to May 2012. A total of 1012 HIV positive patients, who attended ART clinic, receiving ART treatment during the study period, were included in the analysis. The statistical analysis was performed using SPSS software (Version 17.0).</p></sec><sec id="st4"><title>Results:</title><p>This study showed 1012/172 (17%) prevalence of pulmonary tuberculosis among HIV positive patients, of which 87 (50.58%) were males and 85 (48.42%) were females. Low CD4 count (< 50/μl) had statistically significant association with HIV/TB co-infection as compared to HIV infection only (<italic>P</italic> < 0.0001).</p></sec><sec id="st5"><title>Conclusion:</title><p>The study showed that 17% of HIV infected persons had tuberculosis co-infection. More strategic preventive measures that enhance body immunity among HIV patients are highly needed as early as possible before they develop active tuberculosis.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Vidyanathan, Ps" uniqKey="Vidyanathan P">PS Vidyanathan</name></author><author><name sortKey="Singh, S" uniqKey="Singh S">S Singh</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Jain, Sk" uniqKey="Jain S">SK Jain</name></author><author><name sortKey="Aggarwal, Jk" uniqKey="Aggarwal J">JK Aggarwal</name></author><author><name sortKey="Rajpal, S" uniqKey="Rajpal S">S Rajpal</name></author><author><name sortKey="Baveja, U" uniqKey="Baveja U">U Baveja</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Stylblo, K" uniqKey="Stylblo K">K Stylblo</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Grange, Jm" uniqKey="Grange J">JM Grange</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Enarson, Da" uniqKey="Enarson D">DA Enarson</name></author><author><name sortKey="Rieder, Hl" uniqKey="Rieder H">HL Rieder</name></author><author><name sortKey="Arnadottir, T" uniqKey="Arnadottir T">T Arnadottir</name></author><author><name sortKey="Trebucq, A" uniqKey="Trebucq A">A Trebucq</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Escott, S" uniqKey="Escott S">S Escott</name></author><author><name sortKey="Nsuteby, E" uniqKey="Nsuteby E">E Nsuteby</name></author><author><name sortKey="Walley, J" uniqKey="Walley J">J Walley</name></author><author><name sortKey="Khan, A" uniqKey="Khan A">A Khan</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Decock, Km" uniqKey="Decock K">KM DeCock</name></author><author><name sortKey="Sero, B" uniqKey="Sero B">B Sero</name></author><author><name sortKey="Coulibaly, Im" uniqKey="Coulibaly I">IM Coulibaly</name></author><author><name sortKey="Lucas, Sb" uniqKey="Lucas S">SB Lucas</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Shafer, Rw" uniqKey="Shafer R">RW Shafer</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Festenstein, F" uniqKey="Festenstein F">F Festenstein</name></author><author><name sortKey="Grange, Jm" uniqKey="Grange J">JM Grange</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Gupta, Mc" uniqKey="Gupta M">MC Gupta</name></author><author><name sortKey="Mahajan, Bk" uniqKey="Mahajan B">BK Mahajan</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Padyana, M" uniqKey="Padyana M">M Padyana</name></author><author><name sortKey="Bhat, Rv" uniqKey="Bhat R">RV Bhat</name></author><author><name sortKey="Dinesha, M" uniqKey="Dinesha M">M Dinesha</name></author><author><name sortKey="Nawaz, A" uniqKey="Nawaz A">A Nawaz</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Kebede, A" uniqKey="Kebede A">A Kebede</name></author><author><name sortKey="Wabe, Nt" uniqKey="Wabe N">NT Wabe</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Narain, Jp" uniqKey="Narain J">JP Narain</name></author><author><name sortKey="Pontali, E" uniqKey="Pontali E">E Pontali</name></author><author><name sortKey="Tripathy, S" uniqKey="Tripathy S">S Tripathy</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Khatri, Gr" uniqKey="Khatri G">GR Khatri</name></author><author><name sortKey="Frieden, Tr" uniqKey="Frieden T">TR Frieden</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Sharma, Sk" uniqKey="Sharma S">SK Sharma</name></author><author><name sortKey="Agarwal, G" uniqKey="Agarwal G">G Agarwal</name></author><author><name sortKey="Seth, P" uniqKey="Seth P">P Seth</name></author><author><name sortKey="Saha, Pk" uniqKey="Saha P">PK Saha</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Paranjape, Rs" uniqKey="Paranjape R">RS Paranjape</name></author><author><name sortKey="Tripathy, Sp" uniqKey="Tripathy S">SP Tripathy</name></author><author><name sortKey="Menon, Pa" uniqKey="Menon P">PA Menon</name></author><author><name sortKey="Mehendale, Sm" uniqKey="Mehendale S">SM Mehendale</name></author><author><name sortKey="Khatavkar, P" uniqKey="Khatavkar P">P Khatavkar</name></author><author><name sortKey="Joshi, Dr" uniqKey="Joshi D">DR Joshi</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Dey, Sk" uniqKey="Dey S">SK Dey</name></author><author><name sortKey="Pal, Nk" uniqKey="Pal N">NK Pal</name></author><author><name sortKey="Chakrabarty, Ms" uniqKey="Chakrabarty M">MS Chakrabarty</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Nissapatorn, V" uniqKey="Nissapatorn V">V Nissapatorn</name></author><author><name sortKey="Christopher, L" uniqKey="Christopher L">L Christopher</name></author><author><name sortKey="Init, I" uniqKey="Init I">I Init</name></author><author><name sortKey="Mun, Yik F" uniqKey="Mun Y">Yik F Mun</name></author><author><name sortKey="Abdullah, Ka" uniqKey="Abdullah K">KA Abdullah</name></author></analytic></biblStruct><biblStruct></biblStruct></listBibl></div1></back></TEI><pmc article-type="research-article"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">N Am J Med Sci</journal-id><journal-id journal-id-type="iso-abbrev">N Am J Med Sci</journal-id><journal-id journal-id-type="publisher-id">NAJMS</journal-id><journal-title-group><journal-title>North American Journal of Medical Sciences</journal-title></journal-title-group><issn pub-type="ppub">2250-1541</issn><issn pub-type="epub">1947-2714</issn><publisher><publisher-name>Medknow Publications & Media Pvt Ltd</publisher-name><publisher-loc>India</publisher-loc></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">23923111</article-id><article-id pub-id-type="pmc">3731868</article-id><article-id pub-id-type="publisher-id">NAJMS-5-367</article-id><article-id pub-id-type="doi">10.4103/1947-2714.114169</article-id><article-categories><subj-group subj-group-type="heading"><subject>Original Article</subject></subj-group></article-categories><title-group><article-title>Prevalence of Pulmonary Tuberculosis Among HIV Positive Patients Attending Antiretroviral Therapy Clinic</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Giri</surname><given-names>Purushottam A</given-names></name><xref ref-type="aff" rid="aff1"></xref><xref ref-type="corresp" rid="cor1"></xref></contrib><contrib contrib-type="author"><name><surname>Deshpande</surname><given-names>Jayant D</given-names></name><xref ref-type="aff" rid="aff1"></xref></contrib><contrib contrib-type="author"><name><surname>Phalke</surname><given-names>Deepak B</given-names></name><xref ref-type="aff" rid="aff1"></xref></contrib></contrib-group><aff id="aff1"><italic>Department of Community Medicine, Rural Medical College and Pravara Rural Hospital, Loni, Maharashtra, India</italic></aff><author-notes><corresp id="cor1"><bold>Address for correspondence:</bold> Dr. Purushottam A. Giri, Department of Community Medicine, Rural Medical College of Pravara Institute of Medical Sciences (Deemed University), Loni, 413 736, Maharashtra, India. E-mail: <email xlink:href="drpgiri14@gmail.com">drpgiri14@gmail.com</email></corresp></author-notes><pub-date pub-type="ppub"><month>6</month><year>2013</year></pub-date><volume>5</volume><issue>6</issue><fpage>367</fpage><lpage>370</lpage><permissions><copyright-statement>Copyright: © North American Journal of Medical Sciences</copyright-statement><copyright-year>2013</copyright-year><license license-type="open-access" xlink:href="http://creativecommons.org/licenses/by-nc-sa/3.0"><license-p>This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.</license-p></license></permissions><abstract><sec id="st1"><title>Background:</title><p>Tuberculosis (TB) is the most common serious opportunistic infection in HIV positive patients and is the manifestation of AIDS in more than 50% of cases in developing countries. TB can occur at any time during the course of HIV infection.</p></sec><sec id="st2"><title>Aim:</title><p>To describe the socio-demographic profile and prevalence of pulmonary tuberculosis (HIV/TB co-infection) among HIV positive patients been attended at the antiretroviral therapy clinic (ART) clinic at tertiary care teaching hospital of western Maharashtra, India.</p></sec><sec id="st3"><title>Materials and Methods:</title><p>A cross-sectional study was carried out at the ART clinic of Pravara Rural Hospital, Loni, from June 2011 to May 2012. A total of 1012 HIV positive patients, who attended ART clinic, receiving ART treatment during the study period, were included in the analysis. The statistical analysis was performed using SPSS software (Version 17.0).</p></sec><sec id="st4"><title>Results:</title><p>This study showed 1012/172 (17%) prevalence of pulmonary tuberculosis among HIV positive patients, of which 87 (50.58%) were males and 85 (48.42%) were females. Low CD4 count (< 50/μl) had statistically significant association with HIV/TB co-infection as compared to HIV infection only (<italic>P</italic> < 0.0001).</p></sec><sec id="st5"><title>Conclusion:</title><p>The study showed that 17% of HIV infected persons had tuberculosis co-infection. More strategic preventive measures that enhance body immunity among HIV patients are highly needed as early as possible before they develop active tuberculosis.</p></sec></abstract><kwd-group><kwd>Antiretroviral therapy clinic</kwd><kwd>HIV infection</kwd><kwd>Prevalence</kwd><kwd>Pulmonary tuberculosis</kwd></kwd-group></article-meta></front><body><sec id="sec1-1"><title>Introduction</title><p>India has the largest number of tuberculosis (TB) cases in the world. India shoulders about 14 million cases of TB and it is estimated that about 1.8 million incident cases of TB occur in India every year of which 0.82 million are highly infectious smear positive cases.[<xref ref-type="bibr" rid="ref1">1</xref>]</p><p>TB was declared a global emergency in the year 1993; recently the Director General of WHO declared AIDS to be a global emergency as well. There exists a synergistic relationship between TB and HIV. The interface between TB and HIV is increased in countries like India where both TB and HIV infection are maximally prevalent in people of 15-49 years of age.[<xref ref-type="bibr" rid="ref2">2</xref>] The association between HIV and tuberculosis present an immediate and grave public health and socioeconomic threat in developing countries.[<xref ref-type="bibr" rid="ref3">3</xref>]</p><p>Persons infected by <italic>Tubercle bacilli</italic> have about a 10% chance of developing tuberculosis during the remainder of their lives: Thus, they have a less than 0.5% chance of developing overt disease annually,[<xref ref-type="bibr" rid="ref4">4</xref>] while 10% of persons infected by both TB and HIV develop tuberculosis disease annually.[<xref ref-type="bibr" rid="ref5">5</xref>] The implication of HIV infection is that it activates dormant tuberculosis to rapid disease progression of tuberculosis and death.[<xref ref-type="bibr" rid="ref6">6</xref>] In fact, tuberculosis is now the most common opportunistic infection in patients from developing countries who die from AIDS.[<xref ref-type="bibr" rid="ref7">7</xref>] Reports show that active tuberculosis increases the morbidity and fatality of HIV-infected person and about one-third die of tuberculosis.[<xref ref-type="bibr" rid="ref5">5</xref>]</p><p>The largest increase in tuberculosis has occurred in locations and demographic groups with the highest HIV prevalence, which suggests that the epidemic of HIV is at least partially responsible for the increase of tuberculosis.[<xref ref-type="bibr" rid="ref8">8</xref>] There is evidence that immune responses in tuberculosis and in other infection induce cytokines that enhance the replication of HIV and this drives the patient into full picture of AIDS.[<xref ref-type="bibr" rid="ref9">9</xref>] Hence, this study was conducted in order to assess the socio-demographic profile and the prevalence of pulmonary tuberculosis among HIV positive patients who attended the ART clinic at tertiary care teaching hospital of western Maharashtra, India.</p></sec><sec sec-type="materials|methods" id="sec1-2"><title>Material and Methods</title><p>The study was approved by the ethical committee of the institute.</p><p>A cross-sectional study was carried out in the ART clinic of Pravara Rural Hospital (PRH), Loni, Maharashtra, India, from June 2011 to May 2012. PRH is a tertiary level health care center attached as a teaching hospital of Rural Medical College, Loni, which caters to the needs of the Ahmednagar district and comes under the aegis of Pravara Medical Trust. A total of 1012 HIV positive patients, who were attended at ART clinic, having < 350/μl CD4 count and receiving ART treatment during study period, were included in the study.</p><p>A predesigned and pretested questionnaire was used to collect data on socio-demographic profile. Blood samples of these subjects were tested for HIV infection using highly specific enzyme-linked immunosorbent assay (ELISA) or Western Blot techniques. All the patients, irrespective of whether they had signs and symptoms of chest infection, were screened for pulmonary TB by chest X-ray, and subsequently by repeated microscopic examination of sputum for acid fast bacillus (AFB) using standard technique. Those individuals who were positive for AFB in their sputum received standard directly observed therapy short-course as per revised national tuberculosis control programme of the Government of India.[<xref ref-type="bibr" rid="ref10">10</xref>] Blood samples were collected periodically after obtaining written informed consent. Blood samples were processed for the CD4 count. Socioeconomic status was assessed by the modified BG Prasad classification.[<xref ref-type="bibr" rid="ref11">11</xref>]</p><sec id="sec2-1"><title>Statistical analysis</title><p>The statistical analysis was performed using SPSS software (Version 17.0). All values are expressed in the form of percentages, mean, and standard deviation and the Chi-square test was applied wherever necessary. Statistical significance was set at <italic>P</italic> ≤ 0.05.</p></sec></sec><sec sec-type="results" id="sec1-3"><title>Results</title><sec id="sec2-2"><title>Socio-demographic characteristics</title><p>It was observed from <xref ref-type="table" rid="T1">Table 1</xref> that, out of the 172 (17%) HIV/TB co-infection patients, 59 (34.30%) were in the age group of 30-40 years, followed by 44 (25.38%) in the age group of 40-50 years, and only 6 (3.40%) in the age group of less than 20 years. The mean age of the patients was 38.1 ± 3.2 years. There were 87 (50.58%) males and 85 (48.42%) females. As per the modified BG Prasad classification, most of the patients 71 (41.28%) belonged to upper middle class followed by 65 (37.79%) lower middle class; while only 9 (5.23%) from upper class. With more than half (63.95%) of the study population were married, while (31.40%) either divorced/widow or separated from their family. Education level of the study population indicated that 46 (26.74%) were illiterates and 87 (50.58%), 22 (12.79%), and 10 (5.81%) had education levels of secondary, primary, and higher secondary, respectively. Only 7 (4.07%) were graduates. Occupation of the study population of HIV/TB co-infection showed that (42.44%) were laborers, followed by (29.65%) was farmers and (15.11%) were driver.</p><table-wrap id="T1" position="float"><label>Table 1</label><caption><p>Socio-demographic profile of HIV/TB co-infection patients</p></caption><graphic xlink:href="NAJMS-5-367-g001"></graphic></table-wrap></sec><sec id="sec2-3"><title>Distribution of CD4 count of HIV and TB cases</title><p>Low CD4 count (< 50/μl) had statistically significant association (<italic>P</italic> < 0.0001) with HIV/TB co-infection as compared to HIV infection only [<xref ref-type="table" rid="T2">Table 2</xref>].</p><table-wrap id="T2" position="float"><label>Table 2</label><caption><p>Distribution of CD4 count of HIV and TB cases</p></caption><graphic xlink:href="NAJMS-5-367-g002"></graphic></table-wrap></sec></sec><sec sec-type="discussion" id="sec1-4"><title>Discussion</title><p>In this study, out of the total 1012 HIV positive patients, who attended the ART clinic and received treatment, 172 (17%) had HIV/TB co-infection and remaining 480 (83%) were HIV positive alone. Similarly a study done by Padyana <italic>et al</italic>.,[<xref ref-type="bibr" rid="ref12">12</xref>] at a tertiary care hospital of South India, among 200 HIV positive patients, showed that 54 (27%) patients had HIV/TB co-infection and remaining 146 (73%) were HIV positive alone. Another study done by Kebede and Wabe[<xref ref-type="bibr" rid="ref13">13</xref>] in South West Ethiopia, among 296 patients on concomitant tuberculosis and antiretroviral therapy at hospital treatment center, of them only 24 (8.1%) were co-infected by HIV and TB.</p><p>In developing countries, TB is one of the most common life-threatening infections among the persons living with HIV/AIDS. An estimate shows that around 5.1 million people are infected with HIV and about half of these cases are co-infected with tuberculosis.[<xref ref-type="bibr" rid="ref14">14</xref>] In India, approximately 200 000 of these HIV-infected persons develop active TB each year.[<xref ref-type="bibr" rid="ref15">15</xref>] Incidence of HIV/TB co-infection was reported to be very high (50%) in sub-Saharan Africa compared to that in Asia.[<xref ref-type="bibr" rid="ref16">16</xref>] The rates of HIV/TB co-infection have been reported to vary in different regions of India. It was found to be between 0.4% and 20.1% in north India.[<xref ref-type="bibr" rid="ref17">17</xref>] However, the incidence was 3.2% in 1991, which increased to 20.1% in 1996 in south India.[<xref ref-type="bibr" rid="ref18">18</xref>]</p><p>This study shows that the prevalence of HIV/TB co-infection was 17% among HIV positive patients who attended the ART clinic in western Maharashtra. This prevalence of HIV/TB co-infection is different from the national figure (60.30%),[<xref ref-type="bibr" rid="ref19">19</xref>] but almost similar (27.3%) to that of another study done by Dev <italic>et al</italic>.,[<xref ref-type="bibr" rid="ref20">20</xref>] in Kolkata.</p><p>Low CD4 cells in HIV-infected persons indicates severely depressed immunity that makes them susceptible to fresh TB infection or reactivation of latent infection and rapid degradation of clinical condition. It has already been established that TB attributed to a six-fold to seven-fold increase of viral load in HIV positive population.[<xref ref-type="bibr" rid="ref21">21</xref>] Unlike cryptococcal meningitis or toxoplasmosis, which occur at very low CD4 counts, TB is unique in that it can occur over a wide range of CD4 counts, although it is more frequent at CD4 counts < 300 cells/μl. According to an estimate of World Health Organization, TB has become one of the leading causes of death among HIV-infected persons.[<xref ref-type="bibr" rid="ref22">22</xref>]</p><p>All HIV-infected individuals should be tested for tuberculosis prior to the initiation of ART in countries like India where tuberculosis is endemic. Several tests including chest x-ray and sputum cultures should be done to all individuals. This will result in early detection and treatment, and thus reduction of spread of disease.</p><sec id="sec2-4"><title>Limitations</title><p>This study was a hospital-based analysis of the HIV/TB co-infected patients and the findings might not be generalizable. HIV/AIDS pandemic has caused a resurgence of TB, resulting in increased morbidity and mortality in urban as well as rural area. In India, most of the prevalence studies of HIV/TB co-infection were carried out only in the urban area, but very few like present study was carried out in the rural area, highlighted that HIV/TB co-infection is also becoming major health problem in the rural area.</p></sec></sec><sec sec-type="conclusions" id="sec1-5"><title>Conclusion</title><p>Since the increase in HIV infection rate leads to increase in tuberculosis disease, there is need to re-examine the strategies for their effective control. The development of programs with an integrated approach to inducing behavioral change and promoting use of condoms may reduce the infectivity of HIV transmitters and the susceptibility of HIV-exposed persons. The most important aspect of this control program is public awareness and good health education on how tuberculosis and HIV are transmitted.</p></sec></body><back><ack><title>Acknowledgments</title><p>We express our deep sense of gratitude to the Management, Pravara Medical Trust and The Principal, Rural Medical College Loni, Maharashtra, India. We also acknowledge the help and support of Dr. P. P. Pargaonkar, Medical Officer, and Dr. Mrs. J. J. Deshpande, Co-ordinator ART Clinic and Medical Interns - Dnyaneshwar Kale, Parag Waghmode, and Piyush More.</p></ack><fn-group><fn fn-type="supported-by"><p><bold>Source of Support:</bold> Nil</p></fn><fn fn-type="conflict"><p><bold>Conflict of Interest:</bold> None declared.</p></fn></fn-group><ref-list><ref id="ref1"><label>1</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Vidyanathan</surname><given-names>PS</given-names></name><name><surname>Singh</surname><given-names>S</given-names></name></person-group><article-title>TB-HIV co-infection in India</article-title><source>NTI Bull</source><year>2003</year><volume>39</volume><fpage>11</fpage><lpage>8</lpage></element-citation></ref><ref id="ref2"><label>2</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Jain</surname><given-names>SK</given-names></name><name><surname>Aggarwal</surname><given-names>JK</given-names></name><name><surname>Rajpal</surname><given-names>S</given-names></name><name><surname>Baveja</surname><given-names>U</given-names></name></person-group><article-title>Prevalence of HIV infection among tuberculosis patients in Delhi-A sentinel surveillance study</article-title><source>Indian J Tuberc</source><year>2000</year><volume>47</volume><fpage>21</fpage><lpage>6</lpage></element-citation></ref><ref id="ref3"><label>3</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Stylblo</surname><given-names>K</given-names></name></person-group><article-title>The global aspects of tuberculosis and HIV infection</article-title><source>Bull Int Union Tuberc Lung Dis</source><year>1990</year><volume>65</volume><fpage>28</fpage><lpage>32</lpage><pub-id pub-id-type="pmid">2350607</pub-id></element-citation></ref><ref id="ref4"><label>4</label><element-citation publication-type="book"><person-group person-group-type="author"><name><surname>Grange</surname><given-names>JM</given-names></name></person-group><person-group person-group-type="editor"><name><surname>Husler</surname><given-names>WJ</given-names><suffix>Jr</suffix></name><name><surname>Sussman</surname><given-names>M</given-names></name></person-group><article-title>Tuberculosis</article-title><source>Topley and Wilson's Micropbiology and Microbial Infections</source><year>1998</year><volume>3</volume><edition>9th ed</edition><publisher-loc>London</publisher-loc><publisher-name>Arnold</publisher-name><fpage>391</fpage><lpage>417</lpage></element-citation></ref><ref id="ref5"><label>5</label><element-citation publication-type="book"><person-group person-group-type="author"><name><surname>Enarson</surname><given-names>DA</given-names></name><name><surname>Rieder</surname><given-names>HL</given-names></name><name><surname>Arnadottir</surname><given-names>T</given-names></name><name><surname>Trebucq</surname><given-names>A</given-names></name></person-group><article-title>International union against tuberculosis and lung disease (IUATLD) Tuberculosis and HIV</article-title><source>Management of tuberculosis, a guide for low income Countries</source><year>2000</year><edition>5th ed</edition><publisher-loc>Paris</publisher-loc><fpage>10</fpage><lpage>53</lpage></element-citation></ref><ref id="ref6"><label>6</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Escott</surname><given-names>S</given-names></name><name><surname>Nsuteby</surname><given-names>E</given-names></name><name><surname>Walley</surname><given-names>J</given-names></name><name><surname>Khan</surname><given-names>A</given-names></name></person-group><article-title>Management of TB in countries with high HIV prevalence</article-title><source>Afr Health</source><year>2001</year><volume>23</volume><fpage>12</fpage><lpage>5</lpage></element-citation></ref><ref id="ref7"><label>7</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>DeCock</surname><given-names>KM</given-names></name><name><surname>Sero</surname><given-names>B</given-names></name><name><surname>Coulibaly</surname><given-names>IM</given-names></name><name><surname>Lucas</surname><given-names>SB</given-names></name></person-group><article-title>Tuberculosis and HIV infection is Sub-Sahara Africa</article-title><source>JAMA</source><year>1992</year><volume>278</volume><fpage>1581</fpage><lpage>7</lpage></element-citation></ref><ref id="ref8"><label>8</label><element-citation publication-type="book"><person-group person-group-type="author"><name><surname>Shafer</surname><given-names>RW</given-names></name></person-group><person-group person-group-type="editor"><name><surname>Broder</surname><given-names>S</given-names></name><name><surname>Merigan</surname><given-names>TC</given-names><suffix>Jr</suffix></name><name><surname>Bolognesi</surname><given-names>D</given-names></name></person-group><article-title>Tuberculosis</article-title><source>Textbook of AIDS medicine</source><year>1994</year><edition>2nd ed</edition><publisher-loc>Baltimore</publisher-loc><publisher-name>Williams and Wilkins (Publisher)</publisher-name><fpage>259</fpage><lpage>82</lpage></element-citation></ref><ref id="ref9"><label>9</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Festenstein</surname><given-names>F</given-names></name><name><surname>Grange</surname><given-names>JM</given-names></name></person-group><article-title>Tuberculosis and the acquired immune deficiency syndrome</article-title><source>J Appl Bacteriol</source><year>1991</year><volume>71</volume><fpage>19</fpage><lpage>30</lpage><pub-id pub-id-type="pmid">1894579</pub-id></element-citation></ref><ref id="ref10"><label>10</label><element-citation publication-type="book"><article-title>World Health Organization</article-title><source>Global tuberculosis control: Surveillance, planning, financing. WHO Report 2008. WHO/ HTM/TB/2008.393</source><year>2008</year><publisher-loc>Geneva</publisher-loc><publisher-name>WHO</publisher-name><fpage>1</fpage><lpage>168</lpage></element-citation></ref><ref id="ref11"><label>11</label><element-citation publication-type="book"><person-group person-group-type="author"><name><surname>Gupta</surname><given-names>MC</given-names></name><name><surname>Mahajan</surname><given-names>BK</given-names></name></person-group><article-title>The text book of preventive and social medicine</article-title><year>2003</year><edition>3rd ed</edition><publisher-loc>New Delhi</publisher-loc><publisher-name>Jaypee Brothers (Publishers)</publisher-name><fpage>117</fpage><lpage>8</lpage></element-citation></ref><ref id="ref12"><label>12</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Padyana</surname><given-names>M</given-names></name><name><surname>Bhat</surname><given-names>RV</given-names></name><name><surname>Dinesha</surname><given-names>M</given-names></name><name><surname>Nawaz</surname><given-names>A</given-names></name></person-group><article-title>HIV-tuberculosis: A study of chest X-Ray patterns in relation to CD4 count</article-title><source>N Am J Med Sci</source><year>2012</year><volume>4</volume><fpage>221</fpage><lpage>5</lpage><pub-id pub-id-type="pmid">22655281</pub-id></element-citation></ref><ref id="ref13"><label>13</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Kebede</surname><given-names>A</given-names></name><name><surname>Wabe</surname><given-names>NT</given-names></name></person-group><article-title>Medication adherence and its determinants among patients on concomitant tuberculosis and antiretroviral therapy in South West Ethiopia</article-title><source>N Am J Med Sci</source><year>2012</year><volume>4</volume><fpage>67</fpage><lpage>71</lpage><pub-id pub-id-type="pmid">22408750</pub-id></element-citation></ref><ref id="ref14"><label>14</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Narain</surname><given-names>JP</given-names></name><name><surname>Pontali</surname><given-names>E</given-names></name><name><surname>Tripathy</surname><given-names>S</given-names></name></person-group><article-title>Sentinel surveillance for HIV infection in tuberculosis patients in India</article-title><source>Indian J Tuberc</source><year>2002</year><volume>49</volume><fpage>17</fpage><lpage>20</lpage></element-citation></ref><ref id="ref15"><label>15</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Khatri</surname><given-names>GR</given-names></name><name><surname>Frieden</surname><given-names>TR</given-names></name></person-group><article-title>Controlling tuberculosis in India</article-title><source>N Eng J Med</source><year>2003</year><volume>347</volume><fpage>1420</fpage><lpage>5</lpage></element-citation></ref><ref id="ref16"><label>16</label><element-citation publication-type="webpage"><article-title>Kaiser Weekly TB/Malaria Report</article-title><source>HIV/TB co-epidemic rapidly is spreading in sub-Saharan Africa</source><date-in-citation>Accessed November 2, 2011</date-in-citation><comment>at
<uri xlink:type="simple" xlink:href="http://www.globalhealth.kff.org/Daily-Reports/2007/02/dr00048620aspx">http://www.globalhealth.kff.org/Daily-Reports/2007/02/dr00048620aspx</uri></comment></element-citation></ref><ref id="ref17"><label>17</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Sharma</surname><given-names>SK</given-names></name><name><surname>Agarwal</surname><given-names>G</given-names></name><name><surname>Seth</surname><given-names>P</given-names></name><name><surname>Saha</surname><given-names>PK</given-names></name></person-group><article-title>Increasing seropositivity among adult tuberculosis patients in Delhi</article-title><source>Indian J Med Res</source><year>2003</year><volume>117</volume><fpage>239</fpage><lpage>42</lpage><pub-id pub-id-type="pmid">14748468</pub-id></element-citation></ref><ref id="ref18"><label>18</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Paranjape</surname><given-names>RS</given-names></name><name><surname>Tripathy</surname><given-names>SP</given-names></name><name><surname>Menon</surname><given-names>PA</given-names></name><name><surname>Mehendale</surname><given-names>SM</given-names></name><name><surname>Khatavkar</surname><given-names>P</given-names></name><name><surname>Joshi</surname><given-names>DR</given-names></name></person-group><article-title>Increasing trend of HIV seroprevalence among pulmonary tuberculosis patients in Pune, India</article-title><source>Indian J Med Res</source><year>1997</year><volume>106</volume><fpage>207</fpage><lpage>11</lpage><pub-id pub-id-type="pmid">9378525</pub-id></element-citation></ref><ref id="ref19"><label>19</label><element-citation publication-type="webpage"><article-title>Govt. of India, Ministry of Health and Family. Welfare, National AIDS Control Organisation</article-title><source>National guidelines for clinical management of HIV/AIDS</source><year>2003</year><date-in-citation>Accessed November 15, 2011</date-in-citation><comment>at
<uri xlink:type="simple" xlink:href="http://www.nacoindia.org">http://www.nacoindia.org</uri></comment></element-citation></ref><ref id="ref20"><label>20</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Dey</surname><given-names>SK</given-names></name><name><surname>Pal</surname><given-names>NK</given-names></name><name><surname>Chakrabarty</surname><given-names>MS</given-names></name></person-group><article-title>Cases of immunodeficiency virus infection and Tuberculosis: Early experience of different aspects</article-title><source>J Indian Med Assoc</source><year>2003</year><volume>101</volume><fpage>291</fpage><lpage>2</lpage><pub-id pub-id-type="pmid">14575217</pub-id></element-citation></ref><ref id="ref21"><label>21</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Nissapatorn</surname><given-names>V</given-names></name><name><surname>Christopher</surname><given-names>L</given-names></name><name><surname>Init</surname><given-names>I</given-names></name><name><surname>Mun</surname><given-names>Yik F</given-names></name><name><surname>Abdullah</surname><given-names>KA</given-names></name></person-group><article-title>Tuberculosis in AIDS Patients</article-title><source>Malays Med Sci</source><year>2003</year><volume>10</volume><fpage>60</fpage><lpage>4</lpage></element-citation></ref><ref id="ref22"><label>22</label><element-citation publication-type="webpage"><article-title>World Health Organization</article-title><source>Tuberculosis facts</source><year>2007</year><date-in-citation>Accessed January 10, 2012</date-in-citation><comment>at
<uri xlink:type="simple" xlink:href="http://www.cdc.gov/hiv/resources/factsheets/hivtb.htm">http://www.cdc.gov/hiv/resources/factsheets/hivtb.htm</uri></comment></element-citation></ref></ref-list></back></pmc></record>Pour manipuler ce document sous Unix (Dilib)
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