CD 4 count stratification and its accuracy in predicting the HIV-Tuberculosis co-infection
DOI:
https://doi.org/10.61529/idjp.v33i2.296Abstract
Background: Co-infection of HIV and TB is a significant public health concern. The relationship between increased HIV replication and low CD4+-TLC in HIV-positive patients with treatment interruptions is well documented. Moreover, TB preventive therapy is highly effective in reducing TB incidence and mortality among HIV-positive patients. The objective of this study was to stratify in terms of different ranges and see the association of CD4+ T-lymphocyte count with different presentations of TB in HIV-positive patients.
Material and Methods: This observational cross-sectional study was conducted from October 2022 to March 2023. A total of seventy-four outdoor and indoor patients were enrolled. Patient data were collected using a structured questionnaire. The MTB gene Xpert, screening for HIV, and CD4+ T-lymphocyte count testing was performed. All the patients aged> 18 years who were found to have positive HIV rapid tests and microbiologically confirmed tuberculosis were included in the study. The CD 4 count was stratified in terms of ranges. The data was analyzed using SPSS 29. The association was established by Spearman's coefficient and odd ratios keeping the significance level <0.05.
Results: 74 patients were enrolled in the study, out of which 67 (90.5%) were males and 7 (9.5%) were females. The mean age of study participants was 38.33 ± 11.43 years (21-78 years) and the mean CD4 count was 85.7 ± 59.48. Most frequent was pulmonary TB; 43 (44.5%) followed by disseminated TB; 11 (24.3%), pleural TB; 9 (9.4%), and TB meningitis 6 (8.1%). There was no association between CD4+ T-lymphocyte count and the site of involvement of TB (p>0.05). Pulmonary TB, miliary TB, TB brain abscess, tuberculomas, and disseminated TB were found more at CD 4 count <100 as signified by the Odd Ratios (1.1, 1.3, 1.3, 1.3, 1.01 within 95% CI)). On the other hand, Pleural TB, Spinal TB, TB lymph adenitis, and TB meningitis were found at CD4 count >100 (4.5, 2.3, 1.51 respectively within 95%CI.
Conclusion: Among HIV-TB co-infected individuals, the frequency of pulmonary TB was found to be highest followed by disseminated TB and pleural TB. No association was found between CD4+ Lymphocyte count and different presentations of TB in this study. The CD4 count is a poor predictor of HIV/TB co-infection unless it is <100. Mostly tuberculosis occurred at count <100 as depicted by odd ratios.
Keywords: CD4+ T-lymphocyte count, Extrapulmonary tuberculosis, HIV-TB co-infection, Pulmonary tuberculosis
References
Yoshimura K. Status of HIV/AIDS in the ART era. J Infect Chemother. 2017; 23(1): 12-16.
DOI: https://doi.org/10.1016/j.jiac.2016.10.002
Malik M, Jamil MS, Johnson CC, Pasha MS, Hermez J, Qureshi SUH. Integrating assisted partner notification within HIV prevention service package for people who inject drugs in Pakistan. J Int AIDS Soc. 2019; 22 Suppl 3(Suppl Suppl 3): e25317. DOI: https://doi.org/10.1002%2Fjia2.25317
Glaziou P, Floyd K, Raviglione MC. Global epidemiology of tuberculosis. Semin Respir Crit Care Med. 2018; 39(3): 271-85. DOI: https://doi.org/10.1055/s-0038-1651492
Scott L, da Silva P, Boehme CC, Stevens W, Gilpin CM. Diagnosis of opportunistic infections: HIV co-infections - tuberculosis. Curr Opin HIV AIDS. 2017; 12(2): 129-38.
DOI: https://doi.org/10.1097/coh.0000000000000345
Glaziou P, Falzon D, Floyd K, Raviglione M. Global epidemiology of tuberculosis. Semin Respir Crit Care Med. 2013; 34(1): 3-16.
DOI: https://doi.org/10.1055/s-0038-1651492
Bayabil S, Seyoum A. Joint modeling in detecting predictors of CD4 cell count and status of tuberculosis among people living with HIV/AIDS under HAART at Felege Hiwot teaching and specialized hospital, North-West Ethiopia. HIV AIDS (Auckl). 2021; 13:527-37.
DOI: https://doi.org/10.2147%2FHIV.S307069
Kiros T, Dejen E, Tiruneh M, Tiruneh T, Eyayu T, Damtie S, et al. Magnitude and associated factors of pulmonary tuberculosis among HIV/AIDS patients attending antiretroviral therapy clinic at Debre Tabor specialized hospital, Northwest Ethiopia, 2019. HIV AIDS (Auckl). 2020; 12: 849-58. DOI: https://doi.org/10.2147/hiv.s282616
Henry RT, Jiamsakul A, Law M, Losso M, Kamarulzaman A, Phanuphak P, et al. SECOND-LINE Study Group. Factors associated with and characteristic of HIV/Tuberculosis Co-Infection: A retrospective analysis of SECOND-LINE clinical trial participants. J Acquir Immune Defic Syndr. 2021; 87(1): 720-9.
DOI: https://doi.org/10.1097/qai.0000000000002619
Maimaiti R, Zhang Y, Pan K, Mijiti P, Wubili M, Musa M, et al. High prevalence and low cure rate of tuberculosis among patients with HIV in Xinjiang, China. BMC Infect Dis. 2017; 17(1): 15. DOI: https://doi.org/10.1186/s12879-016-2152-4
Chaisson LH, Saraceni V, Cohn S, Seabrook D, Cavalcante SC, Chaisson RE, et al. CD4+ cell count stratification to guide tuberculosis preventive therapy for people living with HIV. AIDS. 2020; 34(1): 139-47.
DOI: https://doi.org/10.1097/qad.0000000000002398
Zerdali E, Nakir İY, Sürme S, Sayılı U, Yıldırım M. Predictors for tuberculosis co-infection in people living with HIV/AIDs. Afr Health Sci. 2021; 21(3): 995-1002.
DOI: https://doi.org/10.4314%2Fahs.v21i3.6
Meintjes G, Brust JCM, Nuttall J, Maartens G. Management of active tuberculosis in adults with HIV. Lancet HIV. 2019; 6(7): e463-74.
DOI: https://doi.org/10.1016/s2352-3018(19)30154-7
Kwan CK, Ernst JD. HIV and tuberculosis: A deadly human syndemic. Clin Microbiol Rev. 2011; 24(2): 351-76.
DOI: https://doi.org/10.1128%2FCMR.00042-10
Leeds IL, Magee MJ, Kurbatova EV, del Rio C, Blumberg HM, Leonard MK, et al. The site of extrapulmonary tuberculosis is associated with HIV infection. Clin Infect Dis. 2012; 55(1): 75-81. DOI: https://doi.org/10.1093/cid/cis303
Ahmed A, Hashmi FK, Khan GM. HIV outbreaks in Pakistan. Lancet HIV. 2019;6(7): e418.
DOI: https://doi.org/10.1016/S2352-3018(19)30179-1
Folasayo AT, Oluwasegun AJ, Samsudin S, Saudi SN, Osman M, Hamat RA. Assessing the knowledge level, attitudes, risky behaviors, and preventive practices on sexually transmitted diseases among university students as future healthcare providers in the central zone of Malaysia: A cross-sectional study. Int J Environ Res Public Health. 2017; 14(2): 159.
DOI: https://doi.org/10.3390/ijerph14020159
Nouchi A, Caby F, Palich R, Monsel G, Caumes AE. Travel-associated STI amongst HIV and non-HIV infected travelers. J Travel Med. 2019; 26(8): taz090.
DOI: https://doi.org/10.1093/jtm/taz090
Miyahara R, Piyaworawong S, Naranbhai V, Prachamat P, Kriengwatanapong P, Tsuchiya N, et al. Predicting the risk of pulmonary tuberculosis based on the neutrophil-to-lymphocyte ratio at TB screening in HIV-infected individuals. BMC Infect Dis. 2019; 19(1): 667.
DOI: https://doi.org/10.1186%2Fs12879-019-4292-9
Álvaro-Meca A, Díaz A, de Miguel Díez J, Resino R, Resino S. Environmental factors related to pulmonary tuberculosis in HIV-Infected patients in the combined antiretroviral therapy (cART) era. PLoS One. 2016; 11(11): e0165944.
DOI: https://doi.org/10.1371/journal.pone.0165944
Isomiddin U, Umrzok S. Features of the clinical course, the state of diagnosis and treatment of HIV-associated pulmonary tuberculosis in modern conditions literature review. Annals RSCB [Internet]. 2021; 25 (4): 1809-28.
Hasnain J, Memon GN, Memon A, Channa AA, Creswell J, Shah SA. Screening for HIV among tuberculosis patients: a cross-sectional study in Sindh, Pakistan. BMJ Open. 2012; 2(5): e001677.
DOI: https://doi.org/10.1136/bmjopen-2012-001677
Click ES, Moonan PK, Winston CA, Cowan LS, Oeltmann JE. Relationship between Mycobacterium tuberculosis phylogenetic lineage and clinical site of tuberculosis. Clin Infect Dis. 2012; 54(2): 211-9.
DOI: https://doi.org/10.1093/cid/cir788
Nair N, Wares F, Sahu S. Tuberculosis in the WHO South-East Asia Region. Bull World Health Organ. 2010; 88(3): 164. DOI: https://doi.org/10.2471%2FBLT.09.073874
Qian X, Nguyen DT, Lyu J, Albers AE, Bi X, Graviss EA. Risk factors for extrapulmonary dissemination of tuberculosis and associated mortality during treatment for extrapulmonary tuberculosis. Emerg Microbes Infect. 2018; 7(1): 102. DOI: https://doi.org/10.1038/s41426-018-0106-1
Kingkaew N, Sangtong B, Amnuaiphon W, Jongpaibulpatana J, Mankatittham W, Akksilp S, et al. HIV-associated extrapulmonary tuberculosis in Thailand: epidemiology and risk factors for death. Int J Infect Dis. 2009; 13(6): 722-9.
DOI: https://doi.org/10.1016/j.ijid.2008.11.013
Kipp AM, Stout JE, Hamilton CD, Van Rie A. Extrapulmonary tuberculosis, human immunodeficiency virus, and foreign birth in North Carolina, 1993 - 2006. BMC Public Health. 2008; 8: 107.
DOI: https://doi.org/10.1186/1471-2458-8-107
Jeon D. Tuberculous pleurisy: an update. Tuberc Respir Dis (Seoul). 2014; 76(4): 153-9.
DOI https://doi.org/10.4046%2Ftrd.2014.76.4.153
Kesari SP, Basnett B, Chettri A. Spectrum of Tuberculous Infection in Patients Suffering from HIV/AIDS, and Its Correlation with CD-4 Counts: A Retrospective Study from Sikkim. Indian J Otolaryngol Head Neck Surg. 2019; 71(2): 167-171. DOI: https://doi.org/10.4046/trd.2014.76.4.153
Cui Z, Lin M, Nie S, Lan R. Risk factors associated with tuberculosis among people living with HIV/AIDS: A pair-matched case-control study in Guangxi, China. PLoS One. 2017; 12(3): e0173976.
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