Introduction: Tuberculosis is a major public health problem in the world, especially in the developing countries like India. Also MDR-TB and HIV: TB co-infection are major hurdles to achieve the aim and objectives of our national tuberculosis programme.
1. To diagnose Mycobacterium tuberculosis (MTB) infection in clinically suspected cases of pulmonary tuberculosis using Gene Xpert.
2. To find out HIV: TB co-infection rate.
3. To find out prevalence of Rifampicin sensitive and resistant cases in diagnosed tuberculosis patients.
4. To study factors responsible for Rifampicin resistance (MDR-TB)
Material & Methods: This retrospective study included 278 sputum samples from Jan 2015-Dec 2015 from registered RNTCP patients. The samples were subjected to Xpert MTB/RIF Assay for use with the Cepheid Gene Xpert. The Ziehl - Neelsen smear finding was provided by the RNTCP –DOTS regional centres.
Results: A total number of 278 sputum samples were subjected to Gene Xpert analysis in the year 2015. MTB could be detected in 137 (49.28%) cases. In the rest 141 cases where MTB was not detected 14 samples reported error on Gene Xpert. Out of 278 cases, 209 (75.18%) were HIV negative, and 69 (24.82%) were HIV positive. In 69 clinically suspected HIV: TB co-infection cases, MTB could be detected in 22 (31.88%) cases. Out of these 22 cases, 4 (18.18%) were smear positive. Out of 137 MTB detected samples, 117 (85.4%) were rifampicin sensitive, 2 (1.46%) were rifampicin indeterminate resistant and 18 (13.14%) were rifampicin resistant. According to RNTCP programme criteria for suspected MDR –TB, out of 18 MDR-TB cases, 12 (66.67%) cases were - smear positive at diagnosis , retreatment case; 3 (16.67%) cases were - any follow up smear positive, 2 (11.11%) - had contact of known MDR -TB case and 1(5.56%) - was HIV: TB case.
Conclusion: Gene Xpert was a useful tool in detection of HIV-TB co-infection. In our study out of 69 clinically suspects HIV: TB co-infection cases, one third cases were confirmed by Gene Xpert. Thus, 44 patients were not put on unnecessary AKT and were kept on follow-up. Even though the association of MDR-TB and HIV co-infection was not very significant in this study, it would not be too long before witnessing a rapid increase of MDR-TB among HIV patients if adequate and immediate measures are not taken. In the present study, MDR-TB detection rate was high among re-treatment cases. Emphasis has to be given for completion of primary treatment on time and taking proper nutrition. Patients usually stop treatment once they feel better within 2 month of starting the treatment. Special counselling and education is needed at this juncture. In our study, two cases of primary MDR-TB were from household contact. Hence, health workers must generate awareness and educate patients and family members about the risk of acquiring Primary MDR-TB to prevent its spread.
Gene Xpert, Pulmonary tuberculosis, MDR-TB, HIV: TB co-infection