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CD4 lymphocyte dynamics in Tanzanian pulmonary tuberculosis patients with and without HIV co-infection.

ABSTRACT: The interaction of HIV and tuberculosis (TB) on CD4 levels over time is complex and has been divergently reported.CD4 counts were assessed from time of diagnosis till the end of TB treatment in a cohort of pulmonary TB patients with and without HIV co-infection and compared with cross-sectional data on age- and sex-matched non-TB controls from the same area.Of 1,605 study participants, 1,250 were PTB patients and 355 were non-TB controls. At baseline, HIV was associated with 246 (95% CI: 203; 279) cells per ?L lower CD4 counts. All PTB patients had 100 cells per ?L lower CD4 counts than the healthy controls. The CD4 levels were largely unchanged during a five-month of TB treatment. HIV infected patients not receiving ART at any time and those already on ART at baseline had no increase in CD4 counts after 5 months of TB treatment, whereas those prescribed ART between baseline and 2 months, and between 2 and 5 months increased by 69 (22;117) and 110 (52; 168) CD4 cells per ?L after 5 months.The increase in circulating CD4 levels observed in PTB in patients is acquired after 2 months of treatment irrespective of HIV status. Initiation of ART is the strongest factor correlated with CD4 increase during TB treatment.Clinical trials.gov: NCT00311298.

SUBMITTER: Andersen AB

PROVIDER: S-EPMC3383481 | biostudies-literature | 2012 Mar

REPOSITORIES: biostudies-literature

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CD4 lymphocyte dynamics in Tanzanian pulmonary tuberculosis patients with and without HIV co-infection.

Andersen Aase B AB Range Nyagosya S NS Changalucha John J Praygod George G Kidola Jeremiah J Faurholt-Jepsen Daniel D Krarup Henrik H Grewal Harleen M S HM Friis Henrik H

BMC infectious diseases 20120321

<h4>Background</h4>The interaction of HIV and tuberculosis (TB) on CD4 levels over time is complex and has been divergently reported.<h4>Methods</h4>CD4 counts were assessed from time of diagnosis till the end of TB treatment in a cohort of pulmonary TB patients with and without HIV co-infection and compared with cross-sectional data on age- and sex-matched non-TB controls from the same area.<h4>Results</h4>Of 1,605 study participants, 1,250 were PTB patients and 355 were non-TB controls. At bas ...[more]

PMID: 22436147

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Project description:BACKGROUND:Tuberculosis (TB) and human immunodeficiency virus (HIV) are the leading causes of infectious-disease-related deaths in Ethiopia, but little is known about their spatial distribution across the country. The aim of this study was to investigate the spatial patterns of TB and HIV co-infection in Ethiopia at the district level. METHODS:We conducted an ecological study using TB and HIV data reported from all regions of Ethiopia through the national Health Management Information System (HMIS), between June 2015 and June 2017. Spatial clustering was assessed using Moran's I statistic and Getis-Ord statistic. Spatial binomial regression models were constructed separately for the prevalence of TB among people living with HIV and for the prevalence of HIV among TB patients, with and without spatial components using a Bayesian approach. RESULTS:A total of 1,830,880 HIV and 192,359 TB patients were included in the analysis. The prevalence of HIV among TB patients was 7.34%; hotspots were observed in districts located in Amhara, Afar, and Gambela regions, and cold spots were observed in Oromiya and Southern Nations, Nationalities, and People (SNNP) regions. The prevalence of TB among people living with HIV varied from 0.7% in Oromia region to 14.5% in Afar region. Hotspots of TB prevalence among people living with HIV were observed in districts located in Gambela, Afar, Somali, and Oromiya regions; whereas the cold spots were observed in districts located in Amhara and Tigray regions. The ecological-level factors associated with the prevalence of TB among people living with HIV were low wealth index (OR: 1.49; 95% CrI: 1.05, 2.05), low adult literacy rate (OR: 0.67; 95% CrI: 0.46, 0.94), and distance to an international border (OR: 0.61; 95% CrI: 0.40, 0.91). The factors associated with the prevalence of HIV among TB patients were poor health care access (OR: 0.76; 95% CrI: 0.59, 0.95), low wealth index (OR: 1.31; 95% CrI: 1.01, 1.67), and low adult literacy rate (OR: 1.37; 95% CrI: 1.03, 1.78). CONCLUSION:Our study provides evidence for geographic clustering of TB/HIV co-infection in Ethiopia. Health care access, proximity to international borders, and demographic factors such as low wealth index and adult literacy were significantly associated with the prevalence of TB/HIV co-infection.

Project description:BackgroundHIV-1 mediated dysregulation of the immune response to tuberculosis and its effect on the response to antitubercular therapy (ATT) is incompletely understood. We aimed to analyse the inflammatory profile of patients with tuberculosis with or without HIV-1 co-infection undergoing ATT, with specific focus on the effect of ART and HIV-1 viraemia in those co-infected with HIV-1.MethodsIn this prospective cohort study and immunological network analysis, a panel of 38 inflammatory markers were measured in the plasma of a prospective patient cohort undergoing ATT at Khayelitsha Site B clinic, Cape Town, South Africa. We recruited patients with sputum Xpert MTB/RIF-positive rifampicin-susceptible pulmonary tuberculosis. Patients were excluded from the primary discovery cohort if they were younger than 18 years, unable to commence ATT for any reason, pregnant, had unknown HIV-1 status, were unable to consent to study participation, were unable to provide baseline sputum samples, had more than three doses of ATT, or were being re-treated for tuberculosis within 6 months of their previous ATT regimen. Plasma samples were collected at baseline (1-5 days after commencing ATT), week 8, and week 20 of ATT. We applied network and multivariate analysis to investigate the dynamic inflammatory profile of these patients in relation to ATT and by HIV status. In addition to the discovery cohort, a validation cohort of patients with HIV-1 admitted to hospital with CD4 counts less than 350 cells per μL and a high clinical suspicion of new tuberculosis were recruited.FindingsBetween March 1, 2013, and July 31, 2014, we assessed a cohort of 129 participants (55 [43%] female and 74 [57%] male, median age 35·1 years [IQR 30·1-43·7]) and 76 were co-infected with HIV-1. HIV-1 status markedly influenced the inflammatory profile regardless of ATT duration. HIV-1 viral load emerged as a major factor driving differential inflammatory marker expression and having a strong effect on correlation profiles observed in the HIV-1 co-infected group. Interleukin (IL)-17A emerged as a key correlate of HIV-1-induced inflammation during HIV-tuberculosis co-infection.InterpretationOur findings show the effect of HIV-1 co-infection on the complexity of plasma inflammatory profiles in patients with tuberculosis. Through network analysis we identified IL-17A as an important node in HIV-tuberculosis co-infection, thus implicating this cytokine's capacity to correlate with, and regulate, other inflammatory markers. Further mechanistic studies are required to identify specific IL-17A-related inflammatory pathways mediating immunopathology in HIV-tuberculosis co-infection, which could illuminate targets for future host-directed therapies.FundingNational Institutes of Health, The Wellcome Trust, UK Research and Innovation, Cancer Research UK, European and Developing Countries Clinical Trials Partnership, and South African Medical Research Council.

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CD4 lymphocyte dynamics in Tanzanian pulmonary tuberculosis patients with and without HIV co-infection.

Publications

CD4 lymphocyte dynamics in Tanzanian pulmonary tuberculosis patients with and without HIV co-infection.

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