Abstract
BackgroundTuberculosis (TB) presents a serious problem in Mozambique. HIV prevalence among TB patients is estimated at 47%. A delay in having their first CD4+ cell count could lead to a missed opportunity for ART initiation due to a CD4+ cell increase above the cut-off caused by TB treatment. The objective is to describe CD4+ cell response during TB treatment and quantify the effect of TB treatment and ART on this response.MethodsAll new HIV + adult TB cases in 2007 from three TB clinics in Mozambique were included. Data on TB diagnosis and treatment and HIV parameters were collected. A general mixed model was used for CD4+ cell count response.Results338 HIV + patients were notified and 252 (75%) were included in the analysis. Using TB medication was not independently associated with the CD4+ count response (19 cells/mm3; 95% CI: -40 to 79; p = 0.529). ART-use was associated with statistically significantly higher CD4+ cells compared to no ART-use (81 cells/mm3; 95% confidence interval (CI): 12 to 151; p = 0.022).ConclusionIn this study, no independent effect of TB treatment on CD4+ cell count was found. HIV-infected TB patients on ART had a significantly higher CD4+ cell count than those not receiving ART. CD4+ cell counts for patients not on ART at TB treatment start, remained below the cut off for initiating ART during the first three months of TB treatment; therefore some delay in getting the first CD4+ cell count would not lead to missing the opportunity to start ART.
Highlights
Tuberculosis (TB) presents a serious problem in Mozambique
The increase in TB notifications is partly driven by the Human Immunodeficiency Virus (HIV) epidemic [2]
This study showed a small increase in CD4+ cell count during TB treatment in both patients on antiretroviral therapy (ART) and patients not on ART as has been described in nonimmune compromised TB patients [10,11]
Summary
Tuberculosis (TB) presents a serious problem in Mozambique. HIV prevalence among TB patients is estimated at 47%. Tuberculosis (TB) presents a serious problem in Mozambique with case notifications rising dramatically since the start of this century. The increase in TB notifications is partly driven by the Human Immunodeficiency Virus (HIV) epidemic [2]. The national HIV prevalence is estimated at 15%, based on antenatal sentinel surveillance among pregnant women 15 to 49 years of age [3]. WHO estimated the HIV prevalence in adult TB cases at 47% in 2007 [1]. In Sub Saharan Africa, people unaware of their HIVinfection present often to the health care services with TB as the first AIDS defining illness. Several studies found that TB clinics are well positioned to identify new HIV-infected individuals and to provide access to HIV services [4,5]
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