GO Echejoh, MN Tanko, AN Manasseh, SE Ogala-Echejoh, BM Mandong, EN Okeke
Human immunodeficiency virus (HIV) and tuberculosis co-infection in an individual constitutes a serious diagnostic and therapeutic challenge. The diagnosis of tuberculosis using hypersensitivity skin reaction such as the Mantoux test could turn out to be a poor predictor in an immunocompromised individual, and the yield of mycobacterium tuberculosis from sputum or gastric washings is also poor. We undertook this study to determine liver involvement in HIV and tuberculosis co-infection. Prospective liver biopsies were done on 67 patients who died of complications of HIV/TB co-infections. Liver tissue cores were obtained using the blind percutaneous approach. The tissues were fixed in 10% buffered formal saline and then subjected to routine tissue processing. The slides were read independently by the pathologists. The results of a total of 67 biopsies, comprising of 33 males and 34 females were analysed. Thirty nine (58.2%) had pulmonary tuberculosis (PTB) while 26 (38.8%) had disseminated tuberculosis (DTB). Two (3%) had tuberculous meningitis (TBM). Fourteen (36%) patients with PTB, 10 (38%) with DTB and one (50%) with TBM had hepatic granuloma with caseation. Histologically granuloma 25 (37.4%), chronic hepatitis 13 (19.4%), non-specific reactive hepatitis 11 (16.4%), steatosis nine (13.4%), and cirrhosis seven (10.4%) were found. The age of the patients ranged from 18 - 55 years (mean 35.5 ± 8.4 years). This study shows that liver is frequently involved by TB and other opportunistic infections in HIV/TB co-infection irrespective of whether it’s PTB, DTB or TBM.
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