Tuberculosis prevalence and associated factors among persons infected with human immunodeficiency virus in three West African countries -(Benin, Guinea, Senegal).

Abstract

Background: Tuberculosis (TB) is a leading cause of morbidity and mortality in people living with human immunodeficiency virus (HIV). Data are very scarce on the burden of TB in HIV patients in Sub-saharan African populations. This study aimed to determine the prevalence of pulmonary tuberculosis (PTB) and associated factors among people living with human immunodeficiency virus (HIV) in three West African countries: Benin, Guinea, and Senegal.

Methods: A cross-sectional study was conducted among people living with HIV in three outpatient care centres (one in each country). All HIV-positive patients included in this study were routinely screened for PTB using microscopy, GeneXpert and culture. Participants free of TB were reassessed clinically and biologically six months later. Data were analyzed using R-3.4.3 software. Logistic regression was used to identify factors associated with PTB.

Results: A total of 2859 participants were enrolled in the study, of whom 2820 were screened for TB, 1000 were ARV-naive (35.46%), and 1820 were on ARV prior to screening (64.54%). A total of 127 cases of bacteriologically confirmed PTB (BCPTB) were diagnosed: 117 at baseline and 10 at the 6-month visit. The overall prevalence of BCPTB was 7.90% [95% CI: 6.38-9.75] for ARV-naive participants and 2.64% [95% CI: 1.99-3.48] for participants on ARV at the time of screening. Participants from Guinea were more likely to be diagnosed with TB (OR: 2.95 [95% CI: 1.60-5.45], p=0.001). Underweight HIV-positive patients had higher odds of TB diagnosis (OR: 2.09 [95% CI: 1.40-3.12], p<0.001), while overweight/obesity was associated with lower odds of TB (OR: 0.35 [95% CI: 0.15-0.81], p=0.015). Other factors associated with BCPTB in HIV patients were male sex (OR: 1.81 [95% CI: 1.18-2.77], p=0.007), CD4 count <200/ml (OR: 2.24 [95% CI: 1.15-4.37], p=0.018), and irregular disease follow-up (OR: 2.57 [95% CI: 1.29-5.15], p=0.018).

Conclusion: The prevalence of TB among people living with HIV is high in Benin, Guinea and Senegal. These results highlight the need to improve TB screening and diagnosis in PLHIV, especially in ARV-naive patients.