Abstract
Abstract TB is the leading cause of death in HIV-infected persons. Anti-TB treatment in TB/HIV co-infected persons is therefore a public health priority. In patients undergoing anti-TB treatment and ART, ART initiation is often deferred by 2–8 weeks at the physician’s discretion in patients presenting CD4 counts >350 cells/ml to sufficiently reduce the Mtb burden in order to minimize potential drug interactions and complications related to the immune reconstitution inflammatory syndrome (IRIS). However, we currently lack reliable “real time” diagnostic methods to assess Mtb clearance during TB treatment. Isolation of Mtb from sputum can take 4–6 weeks and the rate of sputum smear-negative/active TB cases is upto 66% higher in HIV(+) than in HIV (−) patients. PCR-based technology while sensitive, does not differentiate between live and dead Mtb. We have recently identified specific host immune activation markers (CD38 and HLA-DR) on Mtb-specific CD4+ T cells that correlate with Mtb clearance during and after TB treatment of HIV (−) pulmonary active TB using flow cytometry. We have extended these studies to assess the performance of these biomarkers in diagnosing ATB in HIV(+) patients. Further, we are exploring the value of these biomarker profiles on T cells from TB/HIV co-infected patients undergoing ART and TB treatment, to evaluate their potential to serve as clinical correlates of Mtb clearance in ART treated TB/HIV+ patients.
Published Version
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