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HIV-infected presumptive tuberculosis patients without tuberculosis: How many are eligible for antiretroviral therapy in Karnataka, India?

HIV-infected presumptive tuberculosis patients without tuberculosis: How many are eligible for antiretroviral therapy in Karnataka, India?
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Kumar AM, Singarajipura A, Naik B, Guddemane DK, Patel Y, Shastri S, Kumar S, Deshmukh R, Rewari BB, Harries AD,


Kumar AM, Singarajipura A, Naik B, Guddemane DK, Patel Y, Shastri S, Kumar S, Deshmukh R, Rewari BB, Harries AD, (click to view)

Kumar AM, Singarajipura A, Naik B, Guddemane DK, Patel Y, Shastri S, Kumar S, Deshmukh R, Rewari BB, Harries AD,

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Journal of epidemiology and global health 2016 01 257(1) 11-19 pii 10.1016/j.jegh.2015.12.002

Abstract

For certain subgroups within people living with the human immunodeficiency virus (HIV) [active tuberculosis (TB), pregnant women, children <5years old, and serodiscordant couples], the World Health Organization recommends antiretroviral therapy (ART) irrespective of CD4 count. Another subgroup which has received increased attention is "HIV-infected presumptive TB patients without TB". In this study, we assess the proportion of HIV-infected presumptive TB patients eligible for ART in Karnataka State (population 60million), India. This was a cross-sectional analysis of data of HIV-infected presumptive TB patients diagnosed in May 2015 abstracted from national TB and HIV program records. Of 42,585 presumptive TB patients, 28,964 (68%) were tested for HIV and 2262 (8%) were HIV positive. Of the latter, 377 (17%) had active TB. Of 1885 "presumptive TB patients without active TB", 1100 (58%) were already receiving ART. Of the remaining 785 who were not receiving ART, 617 (79%) were assessed for ART eligibility and of those, 548 (89%) were eligible for ART. About 90% of "HIV-infected presumptive TB patients without TB" were eligible for ART. This evidence supports a public health approach of starting all "HIV-infected presumptive TB patients without TB" on ART irrespective of CD4 count in line with global thinking about 'test and treat'.

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