CD4 Response of Treatment-Naive HIV-TB Patients with Lower Respiratory Tract Infections in a Tertiary Care Hospital in North India

Background: Most patients develop lower respiratory tract infections of infectious etiology during the course of human immunodeficiency virus (HIV) infection. High burden of tuberculosis (TB) among HIV-infected patients leads to lowering of immunity, thus increasing the incidence of other opportunistic infections. The present study was conducted to discuss the impact of lower respiratory tract infections(LRTI's) including TB in HIV-infected patients. Materials and Methods: A prospective case–control study was done on 180 treatment-naive HIV-seropositive patients and 100 HIV-seronegative controls having LRTIs for a period of 1 year. Expectorated and induced sputum samples were collected and screened for Mycobacterium tuberculosis by smear microscopy. Five milliliter of venous blood was collected from each patient for determination of cluster of differentiation 4+ (CD4+) T-cell lymphocyte counts. Results: Acid-fast bacilli were observed in 40.55% (73/180) of HIV-infected patients compared to 17% (17/100) in seronegative patients ( P < 0.001). About 69.86% (51/73) of HIV-TB co-infected patients had CD4 + T-cell lymphocyte count < 200 cells/μl ( P < 0.05). CD4 + T-cell lymphocyte counts of HIV-TB co-infected patients were comparable to patients having LRTI's other than TB ( P > 0.05). Conclusion: LRTIs lead to a significant lowering of CD4 + T-cell lymphocyte counts among HIV-positive patients. Hence, routine screening along with laboratory confirmation for all lower respiratory tract infections in addition to TB is essential to manage coinfections in HIV patients.