HIV in Tubercular children
Upcoming SlideShare
Loading in...5
×
 

HIV in Tubercular children

on

  • 429 views

 

Statistics

Views

Total Views
429
Views on SlideShare
429
Embed Views
0

Actions

Likes
1
Downloads
3
Comments
0

0 Embeds 0

No embeds

Accessibility

Categories

Upload Details

Uploaded via as Microsoft PowerPoint

Usage Rights

© All Rights Reserved

Report content

Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
  • Full Name Full Name Comment goes here.
    Are you sure you want to
    Your message goes here
    Processing…
Post Comment
Edit your comment

HIV in Tubercular children HIV in Tubercular children Presentation Transcript

  • Presented by Guided byDr. Virendra Gupta Dr. Jagdish Singh SPMCHI, SMS Medical College, Jaipur
  • INTRODUCTION• Tuberculosis (TB) is a leading killer among people living with human immunodeficiency virus (HIV).• More than 33 million people now live with HIV/AIDS, out of them 2.5 million are under the age of 15yr(UNICEF report 2010)• At least one in four deaths among people living with HIV can be attributed to TB.• Addressing the TB and HIV epidemics are key priorities for WHO.
  • HIV Prevalence in Incident TB Cases 2010• Global 23.0%• India 5.0%• Rajasthan 2.0%• Sources: WHO, Global Tuberculosis Control 2011, available at http://www.who.int/tb/publications/global_report/en/index.html. For country data, see also WHO, TB database, available at http://www.who.int/tb/country/data/download/en/index.html.
  • AIMS AND OBJECTIVES• To know the magnitude of HIV infection in patients diagnosed with tuberculosis.• To know the differences in clinical profile of tuberculosis between HIV+ve and HIV-ve patients in pediatric age group
  • MATERIAL AND METHODSStudy design and setting : Hospital based, observational, descriptive study.Subjects : Patients with diagnosis of tuberculosis(as per RNTCP guidelines) attending the pediatric DOTS Center / OPD and IPD Patients of SPMCHI .Sample size : Included 315 eligible patients from Sept. 2011 to Sept. 2012.
  • INCLUSION CRITERIA• Age - 6 weeks to 15 years.• Fulfilling the criteria for diagnosis of tuberculosis. (As per RNTCP guidelines )• Willing to give written informed consent.
  • METHODS• Detailed clinical history• Complete general, physical and systemic examination• Relevant investigations• Fulfilled the criteria for diagnosis of tuberculosis were screened for HIV infection ( As Per NACO Guidelines )
  • NACO Guidelines to diagnose HIV• < 18 Month-DNA PCR 3 Test kits required A1• > 18 Month – A1 +Ve A1 -Ve (Report Negative) 3 Different antibody test A2A1- Combaid Test Kit (ELISA) A1 + A2+ A1+ A2-A2- SD Bioline (Immunochromatographic) ( Report positive ) A3A3- Tridot Test Kit (Immunofiltration) A1+ A2- A3 + A1+ A2- A3 - (Indeterminate ) ( Report Negative)
  • STATISTICAL ANALYSIS• Qualitative Data summarized in percentage & Quantitative data in form of mean +/- SD• Quantitative data analyzed with parametric tests (unpaired t-test) while Qualitative data analyzed with non- parametric tests (χ2 test and z-test for difference of proportions).
  • RESULTSOut of 315 patients, 22 were HIV positive(6.98%) 6.98% HIV +ve HIV-Ve 92.02%
  • Age and sex distribution of total TB patients Age group Male Female Total No.(%) No.(%) No.(%) 06wk -1 year 16 (05.07) 11 (03.49) 27 (08.57) (Infancy) 1y-5y 58 (18.41) 46 (14.60) 104 (33.01) (Pre school ) 5y-10y 54 (17.14) 43 (13.65) 97 (30.79)(School going) >10y 48 (15.24) 39 (12.38) 87 (27.62) (Adolescent) Total 176 (55.87) 139 (44.12) 315
  • Age and Sex Distribution of Total TB Patient Male To Female Ratio - 1.21:1 60 No. of patients 50 40 30 Male 20 Female 10 0 06wk -1 year 1y-5y 5y-10y >10y Male Female TotalMean age 7.18 ± 4.39 Yr 7.30 ± 4.36 Yr 7.23 ± 4.35 Yr
  • OPD/IPD Distribution of Total TB Patient100% 6 90% (27.27%) 80% 215 IPD 70% 221 (73.38%) (70.16%) 60% 50% OPD 40% 16 (72.73%) 30% 78 94 20% (26.62%) (29.84%) 10% 0% HIV+ve Hiv-ve Total
  • Socio-Demogrphic DistributionRural Urban 8 134 126 (36.36%) (42.54%) (43.00%) 14 167 181 (63.64%) (57.00%) (57.46%) HIV+ve Hiv-ve Total
  • Distribution of tuberculosis patients according to type of tuberculosis and HIV serostatus 100% 80% 123 9 161 60% (87.23%) (90%) (98.17%) 40% 18 1 20% 3 (12.77%) (10%) 0% (1.83%) Pulmonary Disseminated Extra- /Miliary Pulmonary HIV-Ve 87.23 90 98.17 HIV+Ve 12.77 10 1.83Chi- square = 86.070 p-value = <0.0001
  • Nutritional Status of Tubercular children according to HIV serostatus Wt/Age % 70.69% 69.95% 72.00% 70.00% 68.00% 66.00% HIV+ve 64.00% 60.37% 62.00% HIV-ve 60.00% 58.00% Total 56.00% 54.00% HIV+ve HIV-ve TotalChi- square = 48.039 p-value = 0.038
  • Comparison of Symptoms profile in HIV +ve And HIV –ve Tubercular Children symptom HIV +ve HIV-ve Total p-value90 81.81% No. No. No.80 71.33% (%) (%) (%)70 63.48% 59.09% 59.09%60 Weight 18 186 206 0.1350 45.05% 45.45% loss (81.81) ( 63.48) (65.39)40 Pyrexia 13 209 222 0.3330 >14 Day (59.09) (71.33) (70.47)20 10.23%10 cough >14 13 132 145 0.290 Day (59.09) (45.05 ) (46.03) Weight Pyrexia cough Loose loss >14 Days >14 Days Motion Loose 10 30 40 <0.001 Motion (45.45) (10.23 ) (12.70) HIV +ve HIV-ve
  • Comparison of Signs in HIV +ve And HIV –ve Tubercular Children 68.18% Sign HIV +ve HIV-ve Total p-value70 62.12% NO NO NO60 (%) (%) (%)50 41.81% Pallor 15 182 197 NS40 27.77% (68.18) (62.12) (62.54)3020 15.35% 13.99% HSM 07 45 52 0.0410 (41.81) (15.35) (60.50)0 Pallor HSM LNP LNP 05 41 46 0.12 (27.77) ( 13.99) (14.60) HIV +ve HIV-ve HSM=Hepatospleenomegaly ,LNP= Lymphadenopathy
  • Comparison of Investigations in HIV+ve And HIV–ve Tubercular Children % 68.18 70 60 54.92 53.92 49.48 48.49 50 40.9 38.1 35.49 40 30 20 7.27 4.434.43 10 0 0 Radiological Mantoux Test BCG Scar Sputum /GA Lesion AFBHIV+ve 68.18 40.9 7.27 0HIV-ve 53.92 49.48 35.49 4.43Total 54.92 48.49 38.1 4.43
  • CONCLUSION• Magnitude of HIV sero-positivity is 6.98% in Tubercular children.• Co-existence of HIV is more with Pulmonary, Disseminated & Miliary tuberculosis than Extra-pulmonary tuberculosis.• HIV positive children suffer more often with severe symptoms.
  • RECOMMENDATIONS• Health personnel need to recognize such dual infection and take proper steps to manage the epidemic.• HIV screening should be carried out in all tubercular children.
  • DR. VIRENDRA GUPTA
  • FLOW CHART 649 CASE DIAGNOSED TB(As Per RNTCP Guidelines ) 334 CASE EXCLUDED •Not Given Consent •Unwilling To Blood Sampling •Drop Out 315 CASES INCLUDED IN STUDY HIV TEST DONE (As Per NACO Guidelines)22 case HIV +Ve 293 CASE HIV -Ve Results are shown after statistical data applied
  • RESULTS• Out of 315 patients, 22 were HIV positive(6.98%).• 57.46% were rural, Most patients were in the school going age (43.80%).• M:F ratio was 1.21:1, Mean weight for age was 69.94%.• History of contact with tuberculosis in 47.94%.• 52.06% of cases had one or more extra-pulmonary tubercular sites.• And 3.17% disseminated or military tuberculosis
  • RESULTS• Out of 315 tubercular children, 22 were HIV positive(6.98%).• 57.46% were rural patients• Most patients were in the school going age (5-12yr)group (43.80%).• Male to female ratio was 1.21:1.• Mean weight for age was 69.94%.• History of contact with tuberculosis in 47.94%.• 52.06% of cases had one or more extra-pulmonary tubercular sites.• And 3.17% disseminated or military tuberculosis
  • Distribution of tuberculosis patients according to type of tuberculosis.. and HIV serostatus Type of disease HIV +Ve HIV –Ve TotalPulmonary 18 (81.81) 123 (41.97) 141 (44.76 )Diss.TB / Mill.TB 1 (04.55) 9 (03.07) 10 (03.17)Extra-pulmonary 3 (13.64) 161 (54.95) 164 (52.06) TOTAL 22 (06.98) 293 (93.02) 315(100) P- Value < .0001
  • Distribution of tuberculosis patients according to type of tuberculosis and HIV serostatus HIV +Ve HIV -Ve 0% 4.5% 4.5% 6% 1% 3% 4.5%4.5% 0% 10% 42% 10% 82% 28% Pulmonary TBM Pleural effusion Lymphadenopathy(LN) Abd. Tb(ABD) other Diss.tb/Mill. Pulmonary TBM
  • Comparison of clinical profile in HIV +ve And HIV –ve Tubercular Children Signs and HIV +ve HIV-ve Total p-valuesymptomsPyrexia >14 13(59.09) 209(71.33) 222(70.47) 0.14 Day cough >14 13(59.09) 132(45.05 ) 145(46.03) 0.07 DayWeight loss 18(81.81) 186( 63.48) 206(65.39) 0.04 Mean 60.37% 70.69% 69.95% 0.03 Wt/AgeLymphadeno 05(27.77) 41( 13.99) 46(14.60) 0.12 pathyHepatosplee 07(41.81) 45(15.35) 52(60.50) 0.04 nomegalyLoos Motion 10(45.45) 30(10.23 ) 40(12.70) <0.0007
  • Comparison of clinical profile in HIV +ve And HIV –ve Tubercular Children 90 80 70 60 50% 40 30 20 10 0 Wt loss Fever > cough HSM Loos BCG L. N . 14 D >14 D Motion Scar HIV +ve 81.81 59.09 59.09 41.81 45.45 27.27 18.18 HIV-ve 63.48 71.33 45.05 15.35 10.23 35.49 20.13
  • Study the Magnitude of HIV Infection in Tubercular Children and Their ClinicalProfileABSTRACTIntroduction: Tuberculosis was noted to be the most frequent cause of death amongst people living withHIV not only in India but all over the world.Aims and objectives: To know the magnitude and differences in clinical profile of HIV infection intubercular children.Study design and setting: Hospital based cross-sectional & descriptive study.Material & method: Study group included patients attending hospital during period Sept. 2011 to Sept.2012, diagnosed with tuberculosis as per NACO guidelines and screened for HIV infection.Results: Out of 315 tubercular children, 22 were HIV positive giving a magnitude of 6.98%, Mostpatients were in the school going age (5-12yr)group (43.80%). The male to female ratio was1.21:1.Mean weight for age was 69.94%. History of contact with tuberculosis was present in 47.94%.Out of HIV positive cases Fever(81.81%),weight loss(81.81%) and weakness(81.81%) were mostfrequent complaints followed by cough(68.18%). Examination showed hepatosplenomegaly(41.81%)and lymphadenopathy(18.18%). Chest X-ray revealed miliary findings in 10.8%.Out of total number, 57.46% were rural patients. 52.06% of cases had one or more extra-pulmonarytubercular sites, and 03.17% disseminated or military tuberculosis. BCG vaccination was seen in only34.92% cases. Overall Mantoux test positivity was 8.49%.Conclusion: Increasing magnitude of HIV seropositivity with positive patients more likely to sufferfrom pulmonary tuberculosis while HIV negative with extra pulmonary involvement. HIV-positivechildren suffer from prolonged symptoms. Health personnel need to recognize such dual infection andtake proper steps to manage the epidemic. HIV screening should be carried out in patients withprolonged illness resistant to usual mode of treatment.Keywords: HIV, Paediatric tuberculosis, Magnitude, seropositivity
  • IAP GUIDELINES
  • RNTCP
  • FINAL DIAGNOSIS
  • -eSa ...............................................dk firk / ekrk/laj{kd………………… fuoklh………………………………. viusiw.kZ Lora= vkSj LoSfPNd :i ls “STUDY OF OCCURRENCEOF HIV IN TUBERCULAR CHILD AND THEIR CLINICALPROFILE” uke ds v/;;u esa vius cPps dks lfEefyr gksus dhlgerh nsrk @nsrh gwW A fpfdRld us eq>s viuh Hkk"kkesa] rFkk tksf[ke vkSj ykHk ds ckjsa esa le>k;k gS A eq>scrk fn;k gS fd [kwu esa HIV dh tkWp, o t:jr iMus ij vU;tkap dh tk;saxh A eq>s ;g Hkh crk;k x;k gS fd esjhxksiuh;rk cukbZ j[kh tk,xh vkSj lHkh tkWp vkSj gLr{ksiesjh lgerh ds ckn gh fd;s tk,xsa A eq>s le>k;k x;k gS fdeS fdlh Hkh oDr] dksbZ dkj.k fn;s fcuk ] fcuk tqekZus dsv?;;u ls ckgj fudy ldrk @ldrh gWw A•Signature / thumb impression……………………..………..…Date………….…• …………………………………………………………….. ……………•name of the mother/ father/guardian……………………………Date…….…….•ekrk@ firk @laj{kd dk uke ………………………………………...….. .……........
  • SEED ARTICLE Prevalence of Human Immunodeficiency Virus Infection in Children with Tuberculosis T. Shahab, M.S. Zoha, M. Ashraf Malik, Abida Malik* and K. Afzal From the Departments of Pediatrics and Microbiology*, Jawaharlal Nehru Medical College, AMU, Aligarh, UP 202 002, India. Correspondence to: Dr. Kamran Afzal, Department of Pediatrics, JN Medical College, Aligarh Mulsim University, Aligarh, UP 202 002, India. E-mail: drkafzal@hotmail.com Manuscript received: July 1, 2003, Initial review completed: August 14, 2003; Revision accepted: November 28, 2003.ABSTRECTThis prospective study was carried out in the pediatric ward and outpatient department of a tertiary carecentre to estimate the prevalence of HIV seropositivity in children with tuberculosis. Two hundred and fiftyconsecutive children below 12 years of age with (pulmonary and Extrapulmonary) tuberculosis diagnosedbetween March 1999 and July 2000 were screened for HIV infection. A patient was labeled as HIV positive iftwo consecutive ELISA tests were found positive using different antigen/principle. Supplemental western blottest was also done. Parents ofseropositive children were also screened for HIV infection and tuberculosis.Total 5 cases were HIV positive giving a seroprevalence of 2%. All the five patients had disseminatedtuberculosis. We suggest regular screening of children with disseminated/miliary tuberculosis for HIV co-infection.
  • DR. VIRENDRA GUPTA
  • REVIEW OF LITERATURE•“PREVALENCE OF HUMAN IMMUNODEFICIENCY VIRUSINFECTION IN CHILDREN WITH TUBERCULOSIS”conducted by Shahab et al. from the AMU, UP, India,CONCLUSION INDIAN PEDIATRICS,VOLUME 41__JUNE 17, 2004)1-An study conducted by Hussain et al.“Seroprevalence of HIV infection among pediatric tuberculosispatients in Agra, India”: from 2003 to 2004,CONCLUSION:2-Recently by National AIDS Control Organization (NACO)
  • S D RAPID KIT TESTGeneral InformationThe SD BIOLINE HIV-1/2 test is an immunochromatographic test for thequalitative detection of antibodies of all isotyoes (IgG, IgM, IgA) specific to HIV-1including subtype O and HIV-2 simultaneously, in human serum, plasma or wholeblood.•3rd Generation Method (Direct Sandwich Method, Ag-Ab-Ag)•Serum, Plasma, Whole Blood•Detects all antibodies including Subtype "O"•Highly sensitive, even to IgM during early infection stage•Differentiation of HIV-1 and HIV-2 by clear 3-line formation.•Sensitivity: 100%, Specificity : 99.8%•Capture Ag: HIV-1 (p24, gp41),HIV-2 (gp36)Ag•Evaluated by WHO (Sensitivity 100%, Specificty 99.3%)•Procured by WHO,UNICEF, etc.•Long shelf life: 24 months at Room Temperature
  • BI-DOT RAPID KIT TESTPRINCIPLE OF THE TESTHIV antigens are immobilized on a porous immunofiltration membrane. Sample and reagents pass through the membraneand are absorbed into the underlying absorbent. As the patients sample passes through the membrane, HIV antibodies, ifpresent, bind to the Immobilized antigens. Conjugate binds to the Fc portion of the HIV antibodies to give distinct pinkishpurple DOT against a white background. (Fig.-3)LIMITATIONS OF THE TEST1. The kit works best when used with fresh samples. Samples which have been frozen and thawed several times containparticulates which can block the membrane, hence resulting in improper flow of reagents and high background colourwhich may make the interpretation of results difficult.2. Optimum test performance depends on strict adherence to the test procedure as described in this manual. Any deviationfrom test procedure may lead to erratic results.3. HIV-1 and HIV-2 viruses share many morphological and biological characteristics. It is likely that due to this, theirantibodies have a cross reactivity of 30-70%. Appearance of test for HIV-1& /or HIV-2 antibodies on the test device does notnecessarily imply co-infection from HIV-1 & HIV-2.4. Some samples show cross reactivity for HIV antibodies. Following factors are found to cause false positive HIV antibodytest results: Naturally occurring antibodies, Passive immunization, Leprosy, Tuberculosis, Myco-bacterium avium, Herpessimplex, Hypergamma-globulinemia, Malignant neoplasms, Rheumatoid arthritis, Tetanus vaccination, Autoimmunediseases, Blood Transfusion, Multiple myeloma, Haemophelia, Heat treated specimens, Lipemic serum, Anti-nuclearantibodies, T-cell leukocyte antigen antibodies, Epstein Barr virus, HLA antibodies and other retroviruses.5. This is only a screening test. All samples detected reactive must be confirmed by using HIV Western Blot. Therefore for adefinitive diagnosis, the patient’s clinical history, symptomatology as well as serological data, should be considered. Theresults should be reported only after complying with above procedure.
  • NACO Guidelines to detect HIV infection in Asymptomatic individuals 3 test kit RequiredSlide 7