HIV co-infection with tuberculous and non-tuberculous mycobacteria in western Kenya: Challenges in the diagnosis and management

Background: Tuberculosis (TB) and HIV co-infections have a global prevalence with devastating morbidity and massive mortality, Sub-Saharan Africa being the worst hit. Objectives: To evaluate the prevalence of TB-HIV co-infection and demonstrate the confusion caused by NTM and HIV/ AIDS co-infection in TB diagnosis and treatment in western Kenya. Methods: In a cross-sectional study carried out at 10 hospitals in western Kenya, sputa from consenting 872 TB suspects underwent microscopy, and culture on Lowenstein-Jensen and Mycobacteria Growth Index Tube media. Isolates were identified using the Hain's GenoType® Mycobacterium CM and GenoType® Mycobacterium AS kits. A total of 695 participants were screened for HIV using Uni-GoldTM test and positives confirmed with the enzyme linked immunosorbent assay. Results: A total of 346 (39.7%) participants were diagnosed with TB. Out of the 346 TB cases, 263 (76%) were tested for HIV infection and 110 (41.8%) of these were sero-positive (co-infected). The female to male TB-HIV co-infection prevalence ratio (PR) was 1.35. This study reports isolation of non-tuberculous mycobacteria from TB suspects at a rate of 1.7%. Conclusion: A high TB-HIV co-infection rate was observed in this study. The NTM disease could be misdiagnosed and treated as TB in western Kenya.