Alex D. W. Acholonu, 1 A,
Njoku2 and Abram Dunbar1
1Department of Biological Sciences
Alcorn State University
Alcorn State, MS 39096
2Medical Entomology and Parasitology Unit, College of Science,
Imo State University, Owerri, Nigeria (rtd)
chiefacholonu@yahoo.com
Abstract
The prevalence of tuberculosis (TB) was
dwindling until the Human Immunodeficiency Virus (HIV)
infection and Acquired Immune Deficiency Syndrome (AIDS)
epidemic started. There have been reported cases of
association of TB caused by Mycobactetium
tuberculosis, with HIV infection. The purpose of
this study was to find out the prevalence of TB and HIV
infection among people from Orlu in Imo State, Nigeria
and augment information on the association of TB and HIV
infection. During the period of August 2004 to September
2005, test samples were collected from both male and
female respondents from Orlu aged one year to sixty
years and examined for TB and HIV infections. Of 8197
specimens examined, 151 (1.84%) were positive for TB and
121 (1.48%) were positive for HIV infection. The age
group with the highest prevalence of TB was 41-50 (3.0%)
and the lowest was 1-10 (0.25%). The highest prevalence
of HIV infection occurred in 21-30 (2.0%) and 41-50
(2.0%) age groups, while the lowest was in 1-10 (1.23%)
age group. The prevalence of TB was slightly more in
females than in males (1.86%; 1.82% respectively). This
was also the case with HIV infection (females, 1.7 %;
males 1.53%). As in previous reports, concurrent
infections of TB and HIV were relatively high (6.0%).
This study adds to reported cases of association of TB
with HIV infection in Nigeria, West Africa, and
Sub-Sahara Africa. It also lends credence to the reports
that the epidemiology of TB has been profoundly
influenced by the epidemic of HIV infection in
Sub-Saharan Africa. It justifies the inclusion of TB as
an opportunistic infection for HIV along with
toxoplasmosis, cryptosporidiosis and Pneumocystis
carinii infection. It is recommended that similar
studies be conducted in the remaining senatorial zones
of Imo State.
Keywords: Tuberculosis (TB), Human
Immunodeficiency Virus (HIV) infection, Imo State
Nigeria
Introduction
Tuberculosis (TB) is a disease of humans
caused by the bacteria, Mycobacterium tuberculosis,the
human tubercle bacillus. It causes disability and death
in many parts of the world. The clinical manifestations
are cough, fatigue, fever, weight loss, hoarseness,
chest pain and hemoptysis (bloody sputum). Tuberculosis
was very rampant in the 1950s and 60s. But there was a
downward trend of morbidity and mortality of this
disease for many years in many countries of the world,
including Nigeria. But in the past decade, there has
been resurgence of its prevalence.
This trend is believed by several
investigators in Nigeria and other countries outside
Nigeria to be as a consequence of the HIV/ AIDS
epidemic. (Hakim et al. 2000; Bello and Njoku 2005;
Peters et al. 2005; Ahidjio et al. 2006) This is
buttressed by the fact that an increase in tuberculosis
cases was reported at the same time as the emergence of
AIDS in several countries (DeCock et al. 1992; Alikor
and Erhabor 2006). Tuberculosis has been reported in
various parts of Nigeria. (Bello and Njoku 2005; Ahidjio
et al. 2006; Peters et al. 2005; Orakwe and Okafor 2005;
Dosumu and Momoh 2006; Kehinke et al. 2006; Ekere et al.
2005; Erhabor et al. 2006; Lawson et al. 2007) A review
of available literature does not show any significant
publication on its prevalence in Orlu, at least in the
past five years.
The first case of Human Immunodeficiency
Virus infection/ Acquired Immunodeficiency syndrome
(HIV/ AIDS) in Nigeria was reported in 1986. The
prevalence escalated from 1.8% in 1988 to 5.8% in 2001.
A survey conducted in 2003 showed that the national HIV
prevalence had dropped to 5% from 5.8% in 2001. However,
it was found that prevalence rates in the various states
varied from as low as 1.2% in Osun state to as high as
12% in Cross River state. On the whole, 13 of Nigeria’s
36 States had an HIV prevalence of over 5%. (http://www.avert.org/aids-nigeria.htm)This
narrowly excluded Imo State which was reported to be 10%
in 1999 and 4.7% in 2001 in Orlu and 5.33% in 1999 and
4.0% in Owerri in 2001. These data were based on
pregnant women attending antenatal clinics examined.
Since this report, some further studies
have been conducted on HIV/AIDS in Imo State. Acholonu
(2005) reported on HIV/ AIDS in Mississippi and
Nigeria. In 2006 Acholonu et al. reported on
trichomoniasis in Imo State, Nigeria with special
reference on Orlu Zone and compared its prevalence with
several other STDs. One of these was HIV infection. Of
8,439 specimens examined, 1.07% was positive for HIV
infection. It was brought out that trichomoniasis,
caused by Trichomonas vaginalis, is a risk factor
for HIV/ AIDS.
There have been several reports on
co-infection of HIV and TB or the association of both (Raviglione
et al. 1992; Harries et al 1997; Hakim et al. 2000; Ige
et al. 2005; Ukaojiofo and Nubila 2006; Daniel and
Alausa 2006; Mayosi et al. 2006). There are also studies
that involved the examination of TB patients for
HIV/AIDS (De Cock et al. 1992; Harries et al. 1997;
Daniel et al. 2004; Mayosi et al. 2006) and HIV/AIDS
patients examined for TB (Raviglione et al. 1992; Salami
and Katibi 2006). The effects in each case were
reported. Survival was adversely affected in patients
co-infected with tuberculosis and HIV. De Cock et al.
(1992) indicated that several reports have documented
the relation of pericardial tuberculosis and HIV
infection with seropositivity being observed in 62-92%
of patients. This was said to be more in Sub-Saharan
Africa. They further stated that high rates (20% to 67%)
of HIV infection in patients with tuberculosis have been
reported form East, West, Central, and Southern Africa.
The epidemiology of tuberculosis has been profoundly
influenced by the epidemic of HIV infection.
The purpose of this study was to find out
the prevalence of TB and HIV infection among people from
Orlu zone of Imo State, Nigeria, the largest of three
zones if the State, and to augment published reports on
the association of TB and HIV infection in Nigeria, West
Africa, and Sub-Saharan Africa at large.
Materials and Methods
During the period of August 2004 to
September 2005, test samples were collected from both
male and female respondents from Orlu aged one year to
sixty years and examined for tuberculosis and HIV
infection. Bacterial diagnosis was carried out.
Acid-fast bacilli stains and mycobacterial cultures were
conducted from blood allowed to clot. For HIV, serum
from each sample of blood allowed to clot was
centrifuged to remove traces of erythrocytes and the
sera were tested serologically using standard methods.
Fig. 1
Map of Nigeria showing Imo State in which
Orlu is located
Fig. 2
Sentinel Surveillance in Pregnant Women in Nigeria (1996-2001)
Ref.
http://www.avert.org/aids-nigeria.htm
Results
Of 8197 specimens examined, 151 (1.84%)
were positive for TB and 121 (1.5%) were positive for
HIV infection. See Tables 1 and 2 and figure 3 for the
rest of the results. They show the following among
others: The highest prevalence of TB was in age
group41-50 (3.0%) and the lowest was in 1-10 (0.25%).
The highest prevalence of HIV infection was in 41-50 age
group (1.84%), closely followed by 21-30 years age group
(1.64), while the lowest was in 1-10 (1.23%). The
prevalence of TB was slightly more in females than in
males (1.86%, 1.82% respectively (P value?)). With
respect to HIV infection, it is slightly more in females
than in males (1.7% and 1.53% respectively (P value=?)).
Prevalence of TB and HIV infection by Age
Group
|
Age Group % |
No. Exam. |
No. Posit TB & % |
No. Posit HIV confirmed & |
|
1-10 |
|
2 (0.25) |
9 (1.11) |
|
11-20 |
981 |
14 (1.43) |
14 (1.43) |
|
|
|
|
|
|
21-30 |
1765 |
37 (2.1) |
29 (1.64) |
|
|
|
|
|
|
31-40 |
1567 |
18 (1.15) |
17 (1.1) |
|
|
|
|
|
|
41-50 |
1852 |
55 (3) |
34 (1.84) |
|
|
|
|
|
|
51-60 |
1221 |
25 (2.0) |
18 (1.5) |
|
|
|
|
|
|
TOTAL |
8197 |
151 (1.84) |
121 (1.5) |
TABLE 2
PREVALENCE OF TUBERCULOSIS AND HIV
INFECTION BY SEX AND AGE GROUP
Age
(Years) |
SEX |
Number Examined |
Number Infected (%) |
|
Tuberculosis |
HIV |
|
SPUTUM
SMEAR POSITIVE |
CONFIRMED
POSITIVE |
|
1- 10 |
M |
420 |
2 (0.5) |
6 (1.43) |
|
|
F |
391 |
0 (0.0) |
3 (0.77) |
|
11-20 |
M |
475 |
5 (1.05) |
4 (0.84) |
|
|
F |
506 |
9 (1.8) |
10 (2.0) |
|
21-30 |
M |
920 |
21 (2.3) |
17 (1.85) |
|
|
F |
845 |
16 (1.87) |
12 (1.42) |
|
31-40 |
M |
766 |
10 (1.3) |
13 (1.7) |
|
|
F |
801 |
8 (1.0) |
4 (0.5) |
|
41-50 |
M |
962 |
24 (2.5) |
12 (1.25) |
|
|
F |
890 |
31 (3.48) |
22 (2.5) |
|
51-60 |
M |
630 |
14 (2.2) |
8 (1.27) |
|
|
F |
591 |
11 (1.86) |
10 (1.7) |
|
TOTAL |
8197 |
151 (1.84) |
121 (1.5) |
Fig. 3
Prevalence of TB and HIV by Age Group
Discussion
The age group with the highest prevalence
of TB was 41-50 (3.0%) and the lowest, 1-10 (0.25%).
This is to be expected. It is generally believed that
mortality and morbidity rates increase with age.
The age group with the highest prevalence
of HIV infection was 41-50 (1.84%) as was the case with
TB, closely followed by 21-30 age group (1.64%) and the
lowest, 1-10 (1.2%). This is to be expected as infection
of children is usually in utero and not sexual
and cases are comparatively few.
The total number of concurrent cases of
TB and HIV was 17 of 283, (6.0%). If TB patients were
isolated and tested for HIV separately as was done by
some investigators, the prevalence would have been much
higher.
The study shows that TB was practically
evenly distributed among the males and females in the
population surveyed (1.82% and 1.86% respectively). The
difference is minimal, (0.04%) or not significant (
P>0.05).
With respect to HIV, it was slightly more
in females than in males (1.7% and 1.53%). So the
difference is not significant (P>0.05). This prevalence
is not as high as expected. This may be due to the fact
that this was involved by a random selected group.
It is apparent that Nigeria is similar to
a number of other African countries (eg. Malawi (Harris
et al. 1997) and Ivory Coast (Cote d’lvoire) (De Cock et
al. 1992) in having an escalating TB related HIV
infection epidemic. There are reports on this situation
in several parts of Nigeria which include Ibadan( Ige et
al, 2005); Shagamu (Peter et al. 2005); Calabar(Daniel
and Alausa 2006); Ife Ife (Erhobor et al. 2006); Enugu (Ukaojiafo
and Nubila 2006); Delta ( Alikor and Erhabor 2006);
Ilorin ( Salamiand Katibi 2006); Abuja ( Dosumu and
Momoh, 2006) Ibadan (Kehinde et al., 2006).Also Dan
Onyejekwe, MD (2007) of the Nigerian Institute of
Medical Research (NIMR) made this observation from his
personal experience with HIV and AIDS patients in Lagos,
Nigeria. (Pers. Comm.)
There was a downward trend of mortality
and morbidity of TB for many years in several countries
ere the HIV epidemic (Benson 1975). But, there has been
a major increase in the prevalence of TB in the past
decade or more, largely as a result of the HIV epidemic
(Hakim et al. 2000). Remedial measures to control this
should be stepped up before it goes back to what it was
previously. “Greatly increased human and natural
resources are required for this neglected problem in
international health (ref. JAMA Vol. 268 NO. 12,
September 23 1992).
As previously stated, this study was
conducted in Orlu Zone of Imo State. It is recommended
that a similar study be conducted in Owerri and Okigwe
Zones of the state to assess the situation in those
areas. Autopsies in Abidjan, Ivory Coast ( Cote d’lvoire)
that showed TB is the most frequent opportunistic
infection in patients dying of AIDS; that there has been
a greatly increased mortality rate in HIV associated TB
( DeCock et al. 1992). Survival is adversely affected in
patients co infected with tuberculosis and HIV. HIV/AIDS
people with TB are at a higher risk of dying than those
without it. It is, therefore, recommended that all HIV
infected patients be screened for TB and if positive, be
treated to prolong their lives Habuim et nal. (2002),
said.
Based on the results of this study, it
can be inferred that there is a downward trend in the
prevalence of HIV infection in Orlu even though the
subjects examined in this study differ from those
reported in the sentinel surveillance of 2001 (only
pregnant women surveyed). (An examination of the results
of the surveillance of 2003 shows that Imo State was not
included. This is made more plausible by the fact that
Acholonu et al. (2006) recorded a prevalence of 1.07%.
This was apparently brought about by the campaign
mounted by the Federal and State governments of Nigeria
against HIV/AIDS as well as Non-Governmental
Organizations (NGOs). But the fight against HIV/AIDS is
far from over and the efforts to control it should be
continued relentlessly until the battle is won. Control
measures should be intensified through what one of us
(Alex D.W. Acholonu) called project DELTA. DELTA (doing
everything locally to stop AIDS) project. That is, work
on this from grass-root level areas, from local
government areas rather than concentrating on urban or
township areas of the country.
Acknowledgements
This study was conducted with support
from Minority Access to Research Careers (MARC) Program.
Grateful acknowledgement is paid to Dan Onyejekwe, MD of
the Nigerian Institute of Medical Research (NIMR),
Lagos, Nigeria for helpful personal information and to
Dr. Babu Patlola of the Department of Biological
Sciences, Alcorn State University, for conducting the
statistical analysis.
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