Nonadherence in tuberculosis treatment among HIV patients attending Bamrasnaradura Hospital, Nonthaburi

Abstract

Objective - To determine the clinical manifestations, outcome and nonadherence, in tuberculosis (TB) among HIV patients in Bamrasnaradura Hospital, Nonthaburi. Design - A retrospective cohort study; hospital record files were reviewed over 11 months. A total of 200 consecutive HIV patients were entered and followed for a 6 months period of their TB treatment. Sociodemographic data, symptoms and signs and results of investigation tests were recorded at the time of presentation, while diagnosis, and clinical outcome were done at the end of the follow-up time. Results - Extrapulmonary tuberculosis (58%) was more common than pure pulmonary involvement (42%). Lymphadenopathy (52%) was the commonest sign on physical examination. Chest X-rays were positive in 55 per cent cases, while AFB examination was positive in 48.5 per cent from the sputum and 46 per cent from lymph node aspirate specimens. After 6 months of treatment, 30 per cent patients were still alive, 12 per cent had died, and 50 per cent were lost to follow-up. Factors such as low socioeconomic status (p<0.001), being newly diagnosed with TB (p<0.001), past history of TB (p<0.003), etc., were statistically significant in predicting the likely nonadherence in TB treatment among HIV patients. Conclusion - In HIV-infected individual, tuberculosis presents more often with extrapulmonary involvement, and the diagnosis is not difficult. While treatment of tuberculosis is successful, patients' compliance is the biggest problem in managing them.