Prevalence of Tuberculosis among HIV-Positive Patients Attending a Tertiary Hospital in South-Eastern Nigeria

Tuberculosis (TB) remains the most prevalent opportunistic infection and a major cause of mortality among individuals living with HIV (PLHIV), particularly in sub-Saharan Africa. Despite advancements in antiretroviral therapy (ART), Nigeria continues to grapple with significant challenges related to TB/HIV co-infection. This study aimed to evaluate the prevalence of TB in HIV-positive patients at the Federal University Teaching Hospital, Owerri (FUTHO), emphasizing various demographic, clinical, and immunological variables. A cross-sectional study involving 100 HIV-positive adults who attended the FUTHO HIV clinic was carried out. Socio-demographic and clinical data were collected through structured questionnaires. TB diagnosis was conducted using symptom-based screening, Ziehl–Neelsen microscopy, and GeneXpert testing. Data analysis was performed using chi-square tests and logistic regression in SPSS version 25. The results indicated that the overall prevalence of TB among PLHIV stood at 30%. The incidence of TB was significantly higher in males (39.5%) compared to females (24.2%, p = 0.042), with the highest rates observed in the 40-49 age bracket (32.1%). We found that prevalence escalated with advancing WHO stages, ranging from 14.3% in Stage I to 50% in Stage IV (p < 0.01). Patients with a CD4 count below 200 cells/µL were at the greatest risk (57.1%) compared to those with counts of 500 cells/µL or greater (9.5%, p < 0.001). Those who had never received ART were disproportionately affected (54.2% vs. 22.4% on ART, p = 0.003). A comprehensive analysis showed that ART-naïve patients with CD4 counts under 200 cells/µL had the highest prevalence (66.7%), while those on ART with CD4 counts of 200 cells/µL or more exhibited the lowest (17.2%). Multivariate regression analysis identified low CD4 count (AOR = 4.72, 95% CI: 1.65-13.51) and ART-naïve status (AOR = 3.41, 95% CI: 1.28-9.06) as key predictors of TB. The prevalence of tuberculosis (TB) among people living with HIV (PLHIV) in this Nigerian tertiary hospital is concerningly high. This scenario is mainly driven by severe immunosuppression and limited access to antiretroviral therapy (ART). The distinct differences across WHO stages, along with the increased risk associated with not starting ART and having low CD4 counts, highlight the urgent requirement for earlier HIV diagnoses, prompt initiation of ART, and more extensive TB prevention strategies. Strengthening diagnostic capabilities and tailoring interventions for high-risk populations are essential to effectively reduce TB-related morbidity and mortality rates in Nigeria.