Assessment of Active Tuberculosis amongst Asymptomatic HIV-infected Patients in Kakinada, India

This study was conducted in 2008.

Tuberculosis (TB) is a major public health threat in India and is the leading cause of morbidity and mortality amongst people living with HIV/AIDS worldwide.1 According to the WHO, India accounts for one-fifth of the global TB incident cases, with over 1.9 million new cases each year, of which .87 million are infectious.2 Annually, 325,000 Indians die from the disease. 

Early detection improves survival and reduces the risk of spread, but current diagnostic methods in limited-resource settings are largely ineffective.3 A recent study in South Africa found nearly 20% of patients starting on antiretroviral therapy (ART) for HIV had culture-positive active pulmonary TB.4 Yet, data on the burden of asymptomatic TB in India is sparse. Without diagnosis and anti-TB therapy (ATT), these individuals will continue to spread the disease.

We hypothesize that the prevalence of culture confirmed TB in HIV-infected Indian patients with CD4 counts less than 350 /μL will be twenty percent, and of these patients, we believe twenty percent will have asymptomatic TB. The proposed study will systematically test this hypothesis by collecting data on the proportion of adults with HIV and low CD4 counts (less than 350 /μL) that have culture-positive pulmonary tuberculosis, but do not present with clinical symptoms. Through a symptom screen, physical examination, acid fast bacilli (AFB) smear and culture, reliable data will be acquired to assist in understanding the transmission of TB in India.