Abstract
BackgroundInfection with the Human Immunodeficiency Virus (HIV) dramatically increases the risk of developing active tuberculosis (TB). Several studies have indicated that co-infection with TB increases the risk of HIV progression and death. Sub-Saharan Africa bears the brunt of these dual epidemics, with about 2.4 million HIV-infected people living with TB. The main objective of our study was to assess whether the pre-HAART CD4+ T-lymphocyte counts and percentages could serve as biomarkers for post-HAART treatment immune-recovery in HIV-positive children with and without TB co-infection.MethodsThe data analyzed in this retrospective study were collected from a cohort of 305 HIV-infected children being treated with HAART. A Lehmann family of ROC curves were used to assess the diagnostic performance of pre- HAART treatment CD4+ T-lymphocyte count and percentage as biomarkers for post-HAART immune recovery. The Kaplan–Meier estimator was used to compare differences in post-HAART recovery times between patients with and without TB co-infection.ResultsWe found that the diagnostic performance of both pre-HARRT treatment CD4+ T-lymphocyte count and percentage was comparable and achieved accuracies as high as 74%. Furthermore, the predictive capability of pre-HAART CD4+ T-lymphocyte count and percentage were slightly better in TB-negative patients. Our analyses also indicate that TB-negative patients have a shorter recovery time compared to the TB-positive patients.ConclusionsPre-HAART CD4+ T-lymphocyte count and percentage are stronger predictors of immune recovery in TB-negative pediatric patients, suggesting that TB co-infection complicates the treatment of HIV in this cohort. These findings suggest that the detection and treatment of TB is essential for the effectiveness of HAART in HIV-infected pediatric patients.
Highlights
Infection with the Human Immunodeficiency Virus (HIV) dramatically increases the risk of developing active tuberculosis (TB)
Study participants The data analyzed in this retrospective study were collected from a cohort of HIV-infected children treated with highly active antiretroviral therapy (HAART) in Accra, Ghana
We examined if the performance pre-HAART CD4+ T-lymphocyte counts and percentages as biomarkers of immune recovery varied by TB status
Summary
Infection with the Human Immunodeficiency Virus (HIV) dramatically increases the risk of developing active tuberculosis (TB). According to the standard of care for clinical and laboratory monitoring of pediatric HIV infection, markers such as plasma HIV RNA and CD4+ T-lymphocyte count should be assessed routinely [2]. The majority of HIV-infected children live in sub-Saharan Africa [3], where such routine monitoring is often unavailable [4, 5]. Even in places where facilities are available, most patients cannot access them consistently [6] The absence of such longitudinal marker measurements makes it difficult to monitor HIV-infected children on highly active antiretroviral therapy (HAART) regimens, which typically last multiple years. Predictive models of HIV disease prognosis will be more clinically useful if they account for the effect opportunistic co-infections, such as tuberculosis (TB) [7]
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