Relationship Risk Factors and Laten Tuberculosis Infection (LTBI) in HIV Patients

Delvan Irwandi, Harsini Harsini, Reviono Reviono


Introduction: In 2014 globally 9.6 million people are infected with TB, including 1.2 million people living with HIV. HIV positive patients have a risk of Tuberculosis (TB), infection or latent TB infection (LTBI) about 5-8% per year and the risk of developing active TB 3 times higher than the immunocompetent individuals. The impact of HIV infection on the immune system is the destruction of lymphocyte T CD4 and declining nutritional status. Nutritional status can be assessed by clinical signs, anthropometry and biochemical indicators such as serum albumin levels.
Methods: Cross-sectional observational epidemiological research in RS Dr. Moewardi, Surakarta, to patients with HIV, from April to May 2017 to observe the association of risk factors with LTBI in HIV patients. The first step is patient and family anamnesis, history of past and family illness, duration of antiretroviral therapy, Cluster of Differentiation 4 (CD4) count, BMI count, serum albumin concentration, immunologic Tuberculin Skin Test (TST) for LTBI diagnosis.
Results: Total of 93 people meet the criteria. There was no association close contact history with active tuberculosis patients with ITBL in HIV (p = 0.5, OR 1.268; 95% CI 1.139-1.411); no association of BMI classification with LTBI in HIV (P=1.000; OR=0.894; 95%CI=0.326-2.457), no association of serum albumin grade with ITBL in HIV (P=0.19; OR=1.284; 95%CI=1.147-1.436); there was a significant association of CD4 classification with LTBI in HIV (P=0.033; OR=3.560; 95%CI=1.214-10.433), there was no association between duration of antiretroviral therapy with LTBI in HIV (P=0.636; OR=0.969; 95% CI=0.244-3.848).
Conclusions: HIV patients with advanced CD4 and severe immunosuppressive CD4 classification (CD4+ <350 cell/mm3) require monitoring to reduce LTBI risk. (J Respir Indo 2019; 39(2))


HIV, LTBI risk, CD4 + cell count <350 cells / mm3


Badan Penelitian dan Pengembangan Kesehatan Departemen Kesehatan RI. Biro Pusat Statistik. Penelitian Kesehatan Rumah Tangga (SKRT) 2014. Kementerian Kesehatan RI. 2015

World Health Organization Regional Office for South-East Asia. Tuberculosis control in the South-East Asia Region. WHO Annual Report. 2016

Burhan E, Soepandi PZ, Isbaniyah F, et al. Pedoman Tatalaksana Infeksi TB Laten. Perhimpunan Dokter Paru Indonesia. Jakarta: Balai Penerbit FKUI. 2016.

Selwyn PA, Hartel D, Lewis VA, et al. A prospective study of the risk of tuberculosis among intravenous drug users with human immunodeficiency virus infection. N.Engl.J.Med. 1989;320(9):545-50.

Mohamed HS, Alothman A, Bonnie HB, Alageeb H. What is the rate of latent tuberculosis infection in human immunodeficiency virus (HIV) infected patients in Saudi Arabia? Am J Epidemiol Infect Dis. 2016;4(1):10-3.

Chen C, Zhu T, Wang Z, Peng H, Kong W, Zhou Y, et al. High latent TB infection rate and associated risk factors in the Eastern China of low TB incidence. PLoS One. 2015;10(10):1-9.

Diedrich CR, Flynn JL. HIV-1/Mycobacterium tuberculosis coinfection immunology how does HIV-1 exacerbate tuberculosis? Infect Immun. 2011;79(4):1407-17.

Riadi A. Tuberkulosis dan HIV-AIDS. JTI. 2012;8:24-9.

Hoffmann C, Rockstroh JK, Kamps BS. HIV Medicine 15th Edition. Paris: Flying Publisher Paris. 2007

Paranjape RS. Immunopathogenesis of HIV infection. Indian J Med Res. 2005;121:240-55.

Ditjen Bina Kesehatan Masyarakat Kementerian Kesehatan RI. Pedoman Pelayanan Gizi Bagi ODHA. Jakarta: Kementerian Kesehatan Republik Indonesia. 2010

Rajeswari G, Gopal PS, Suresh E, Prasad GB. Biochemical changes in HIV related malnutrition in children. IOSR Dent Sci. 2015;14(5):53-7.

Uria GA, Midde M, Pakam R, Naik PK. Diagnostic and prognostic value of serum albumin for tuberculosis in HIV infected patients eligible for antiretroviral therapy: data from an HIV cohort study in India. BioImpacts. 2013;3(3):123-8.

Ditjen Bina Kefarmasian Dan Alat Kesehatan Departemen Kesehatan RI. Pedoman Pelayanan Kefarmasian Untuk Orang Dengan HIV/AIDS (ODHA). Jakarta: Kementerian Kesehatan Republik Indonesia. 2006.

Asfaw A, Ali D, Eticha T, Alemayehu A, Alemayehu M, Kindeya F. CD4 cell count trends after commencement of antiretroviral therapy among HIV-infected patients in Tigray, Northern Ethiopia: A retrospective cross-sectional study. PLoS ONE. 2015;10(3):1-9.

Narasimhan P, Wood J, MacIntyre CR, Mathai D. Risk factors for tuberculosis. Pulmonary Medicine. 2013;2013:1-11.

Ai JW, Ruan QL, Liu QH, Zhang WH. Updates on the risk factors for latent tuberculosis reactivation and their managements. Emerg Microbes Infect. 2016;5(2):1-10.

Martin U, Hasibuan P. Prevalens TB laten pada petugas kesehatan di RSUP H. Adam Malik Medan. J Respir Indo. 2010;30(2):112-8.

Llido LO, Mirasol R. Comparison of Body Mass Index based nutritional status using WHO criteria versus Asian criteria: report from the Philippines. PhilSPEN. 2011;1:1-8.

Brock I, Ruhwald M, Lundgren B, Westh H, Mathiesen LR, Ravn P. Latent tuberculosis in hiv positive, diagnosed by the M. Tuberculosis specific interferon-γ test. Respir Res. 2006;7(1):56-64.

Pusat Data dan Informasi Kementerian Kesehatan RI. Situasi penyakit HIV AIDS di Indonesia [disitasi 10 April 2017]. Diunduh dari: htpp:// publikasi-pusdatin.html..

Shingdang J, Bot Y, Ojo O, Edeh O, Essien C, Bwende E, et al. Serum albumin/ globulin ratio in tuberculosis and HIV patients any relationship? Mycobact Dis. 2016;6(1):1-6.

Talati NJ, Gonzalez-Diaz E, Mutemba C, Wendt J, Kilembe W, Mwananyanda L, et al. Diagnosis of latent tuberculosis infection among HIV discordant partners using interferon gamma release assays. BMC Infect Dis. 2011;11:264-71.

Leidl L, Mayanja-Kizza H, Sotgiu G, Baseke J, Ernst M, Hirsch C, et al. Relationship of immunodiagnostic assays for tuberculosis and numbers of circulating CD4+ T-cells in HIV–infection. Eur Respiratory J. 2009;35:619-26.

Tegbaru B, Wolday D, Messele T, Legesse M, Mekonnen Y, Miedema F, et al. Tuberculin skin test conversion and reactivity rates among adults with and without human immunodeficiency virus in urban settings in Ethiopia. Clin Vaccine Immunol. 2006;13(7):784-9.


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