A Systemic analysis on Response to DOTS Regimen on Opportunistic HIV Infected Patient with Tuberculosis in A Tertiary Care Hospital; A Clinical Pharmacist Perspective to Enhance Healthcare

Hemalatha Selvaraj¹*, Muralikrishnan Dhanasekaran², D. Kumudha³, Kanagaraj Duraisamy⁴

¹Nandha College of Pharmacy, Erode, Tamilnadu, India.

²Department of Drug Discovery and Development, Harrison College of Pharmacy, Auburn University, Auburn, Alabama, USA

³Department of Pharmacy, Karpagam Academy of Higher Education, Coimbatore, India.

⁴Deputy Director of Medical Services, District TB Centre, Erode, Tamilnadu, India.

Background: Opportunistic infections are ailments and pathologies that occur more commonly and radically severely in patients exposed to the human immunodeficiency virus (HIV) due to the impaired and suppressed immune systems.  Tuberculosis is the most common devious opportunistic infection occurring among HIV-positive patients in India. It is estimated about 80% of HIV-positive patients will develop tuberculosis in their lifetime and if not treated appropriately, will result in increased morbidity and mortality. Various global tuberculosis treatment guidelines clearly endorse utilizing an individual patient-centered case management approach by directly observed therapy ("DOT”). In this patient care approach, a trained healthcare employee or other designated individual (excluding a family member) provides the prescribed anti-tuberculosis medications and observes the patient (swallow every dose, monitor for adverse drug reactions). DOT is especially critical for patients with drug-resistant tuberculosis, HIV-infected patients, those on intermittent treatment regimens (i.e., 2 or 3 times weekly), and patients with non-compliance issues.

Objectives: The objectives of the current study were to analyze the prescribing pattern of the medications, assess the patient’s adherence to treatment, evaluate the treatment response, and monitor CD4 lymphocyte count in a tertiary care hospital.

Methodology: A Retrospective and Cross-Sectional study were carried out in the Revised National Tuberculosis Control Programme (RNTCP) Centre at Erode Government Hospital. Patient samples of HIV co-infected with TB were 52 and the study duration was 6 months. Regarding the demographic details of the patients, 52 patients were examined, 31(59.6%) were male and 21(40.39%) were females. 24 (46.15%) of the patients were in age between 21-40 years and 23(44.23%) were between 41-60 years old. Only 2 patients were greater than 60 years old and 3 were below 20 years old.  Regarding their addiction or dependence on different substances of abuse of the patients, 31 male patients 20(38.46%) patients were smokers and 23(44.23%) were alcoholics.

Results: At the initiation of the treatment, the patients exhibited significant cough (day and nighttime), decrease BMI, increased body temperature (fever), dyspnea, chest pain, hemoptysis, and enhanced fatigue. Interestingly, at the end of the treatment regime, almost all the signs and symptoms were significantly reduced in patients, only 12 patients showed fatigue and 6 patients showed the symptom of weight loss. The current study also monitored the CD4 lymphocyte count. 

Conclusion: Regular monitoring of patients’ adherence is inevitable to enhance their response to the DOTS regimen and at the final stage can improve the patient’s quality of life.

Keywords: Opportunistic infections, Tuberculosis, CD4 lymphocyte count, Healthcare, Human Immunodeficiency Virus (HIV)