The Prevalence of M. Tuberculosis Infection and Disease in HIV Positive Individuals in Shiraz, Southern Iran

Background: The emergence of HIV infection and its close association with TB poses an even greater challenge to the health systems and when co-infection is present, it is the most potent risk factor for progression of the disease to an active TB. This study was performed to determine the HIV-seropositive individuals with Mycobacterial infection referring to Center for Counseling and Behavioral Modification in Shiraz, southern Iran. Methods: From January 2004 to December 2006, 459 HIV-positive individuals who referred to Center for Counseling and Behavioral Modification in Shiraz, Southern Iran were enrolled. HIV antibody tests included ELISA and western blot tests, and the tests used for M. tuberculosis infection were PPD skin test, chest x-ray, Ziehl-Neelsen technique, culture in Lowenstein-Jensen medium and pathological examination. Results: 28.5% of HIV-positive individuals had a positive PPD skin test, among whom 89.3% showed a latent tuberculosis infection and 10.7% active tuberculosis. 7.9% of HIV positive patients had active tuberculosis including pulmonary (75.8%) and extrapulmonary types (24.2%). Among the latter cases, 62.5% had TB lymphadenitis, 25% pericarditis and 12.5% TB pleuritis. 40% of those with pulmonary tuberculosis and 50% with exptrapulmonary TB had a positive PPD skin test. Conclusion: As tuberculosis is a common opportunistic infection in HIV-positive patients in Iran with a higher prevalence of extrapulmonary type and the complex clinical presentation of disease, HIV-positive patients should be regularly screened for tuberculosis. Early recognition of latent tuberculosis infection and adequate chemoprophylaxis seem to be essential too.