Predictors, Haematological and Cytokine profiles in Tuberculosis-HIV Coinfection patients during TB treatment and HAART in Coastal Region of Kenya
Shadrack A. Yonge, Michael F. Otieno, Rekha R.Sharma

Abstract
Background: Tuberculosis and HIV Co-infection has become a major public health problem worldwide. Tuberculosis has become the major cause of death in HIV positive patients.HIV infection is characterised by CD4+ lymphocyte depletion manifested through the loss of the immune response capacity. The impact of simultaneous infections on the immune parameters is still not fully explored. Aim: This study was aimed to determine the predictors and estimates of T cell subsets including cytokine profiles of TB-HIV co-infection patients after initiation of dual therapy in Coastal Region, Kenya. Study design: Hospital and laboratory based cross-sectional study was carried between May 2012 and November 2014 at Coast General Referral hospital, Tudor, Port-Reitz, Mlaleo, Likoni and Mikandani districts and Sub-districts hospitals. Methodology: Tuberculosis was diagnosed following standard clinical bacteriological and radiological procedures. Sputa from 500 tuberculosis suspects underwent mycobacteriologic evaluation using Ziel Nelsen smear microscopy, Lowestein and Jensen and BACTEC MGIT 960 culturing. Consenting participants were screened for HIV infection by enzyme -linked immunosorbent assay. CD4+, CD8+cells/μl were analyzed using a BD FACS Count Flow cytometer. These parameters were measured at the time of HAART initiation (30 days after onset of TB treatment) and at the follow-up visits after 30, 60 and 90 days. Results: In Total, 210/500 (42%) of the suspects had Mycobacterial disease and 78/210 (37.1%) were HIV infected 53.8% females and 46.2% males. Age (OR=2.06; 95% CI: 1.1-3.00; p<0.003), marital status (OR=3.54; 95% CI: 2.01-4.65;p<0.0001), baseline CD4 count (OR=3.23; 95% CI: 1.23-8.34; p<0.0001) and WHO clinical stage at presentation (OR=3.84; 95% CI:1.45-7.63; p<0.003) remained significant predictors after adjustment for confounding. Increase of CD4+T cell counts and suppression of HIV viral load were observed for all patients under HAART and TB treatment. Higher values of IFN-Y, IL-2, IL-4, IL-6, IL-10 were observed from the baseline to two months after treatment initiation, whereas reduced levels of TNF- were observed between 60 and 90 days of HAART. Conclusion: Lower CD4 lymphocyte count, substance exposure and WHO clinical stage at presentation were found to be predicting factors for co-infection. Independent of the immunosuppressant profile at baeline, patients under HAART were able to recover the CD4+T cell counts, control viral replication and immune activation parameters overtime.

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