Friday, February 5, 2016

HIV-Infected Presumptive Tuberculosis Patients Without Tuberculosis: How Many Are Eligible for Antiretroviral Therapy in Karnataka, India?

For certain subgroups within people living with the human immunodeficiency virus (HIV) [active tuberculosis (TB), pregnant women, children <5 years old, and serodiscordant couples], the World Health Organization recommends antiretroviral therapy (ART) irrespective of CD4 count. Another subgroup which has received increased attention is "HIV-infected presumptive TB patients without TB". 

In this study, we assess the proportion of HIV-infected presumptive TB patients eligible for ART in Karnataka State (population 60 million), India. This was a cross-sectional analysis of data of HIV-infected presumptive TB patients diagnosed in May 2015 abstracted from national TB and HIV program records. 

Of 42,585 presumptive TB patients, 28,964 (68%) were tested for HIV and 2262 (8%) were HIV positive. Of the latter, 377 (17%) had active TB. Of 1885 "presumptive TB patients without active TB", 1100 (58%) were already receiving ART. Of the remaining 789 who were not receiving ART, 617 (79%) were assessed for ART eligibility and of those, 548 (89%) were eligible for ART. About 90% of "HIV-infected presumptive TB patients without TB" were eligible for ART. 

This evidence supports a public health approach of starting all "HIV-infected presumptive TB patients without TB" on ART irrespective of CD4 count in line with global thinking about 'test and treat'.

Full article at:

  • 1International Union Against Tuberculosis and Lung Disease (The Union), South-East Asia Regional Office, New Delhi, India. Electronic address:
  • 2State TB Cell, Directorate of Health Services, Bangalore, Karnataka, India.
  • 3World Health Organization Country Office, New Delhi, India.
  • 4Karnataka State AIDS Prevention Society, Bangalore, Karnataka, India; National AIDS Control Organization, Ministry of Health and Family Welfare, New Delhi, India.
  • 5National AIDS Control Organization, Ministry of Health and Family Welfare, New Delhi, India.
  • 6International Union Against Tuberculosis and Lung Disease (The Union), Paris, France; London School of Hygiene and Tropical Medicine, London, United Kingdom. 
  •  2016 Jan 25. pii: S2210-6006(15)30080-0. doi: 10.1016/j.jegh.2015.12.002.

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