Prevalence of Disseminated Tuberculosis in Human Immunodeficiency Virus Infected Persons Admitted with Sepsis at a Tertiary Hospital in Western Kenya

Abstract

Background: The current burden of disseminated Tuberculosis in adult Persons Living with Human Immunodeficiency Virus (PLHIV) is unknown in western Kenya. LF LAM is the only test found to have a mortality benefit. Objectives: To determine the prevalence of disseminated TB and the clinical characteristics of HIV-infected persons with disseminated TB. To determine the one-month mortality of participants with LF LAM antigen assay positivity. Methods: Cross-sectional study carried out at the Moi Teaching and Referral Hospital (MTRH) medical wards. Within 24 hours of admission the interviewer administered the questionnaire, and blood and urine samples were collected. Independent variables were summarized using frequencies (%), mean (SD) and median (IQR); dependent variables were analyzed using Student t-test, Chi square and Wilcoxon rank sum test. A p ≤ 0.05 was considered significant. Participants with LF-LAM antigen assay positive were followed up one month after recruitment. Results: Three hundred and ten participants were approached and 298 recruited. Prevalence of disseminated TB was 26% (95% CI 21.2-31.4). Participants LF-LAM positive had a lower hemoglobin level and 65% were not on antiretroviral therapy at the time of recruitment. Participants with positive LF-LAM antigen assay had 27% mortality one month post recruitment. Conclusion and key Recommendations: Using LF-LAM, one out of four PLHIV admitted with sepsis had disseminated TB. This is a high prevalence associated with high mortality. A bedside LF-LAM should be a routine diagnostic test in PLHIV admitted with sepsis and treatment initiated promptly to mitigate the high mortality rate.