CD4 count and tuberculosis risk in HIV-positive adults not on ART: a systematic review and meta-analysis

Ellis, Penelope K.; Martin, Willam J.; Dodd, Peter J.

doi:10.7717/peerj.4165

Cited by 48 publications

(43 citation statements)

References 25 publications

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“…A meta-analysis estimated a 1.43-fold (95% credible interval: 1.16-1.88) increase in TB incidence per 100 cells per mm 3 decrease in CD 4 cell count. 16 In our study, the CD 4 counts of the HIV positive patients ranged between 4 and 338 cells/m³ (median 110 cells/m³); 92.6% of the patients had CD 4 counts of <200 cells/m³ and 25.9% had a CD 4 count of <50 cells/m³, indicating that a significant number of patients had profound immunosuppression at the time of investigation for symptomatic HIV/ TB disease. In a South African study, it was seen that 61.2% had CD4 cell counts <200 cells/μL, 82.7% had counts <350 cells/μL.…”

Section: Discussionmentioning

confidence: 53%

Clinical Profile of Patients with Disseminated Tuberculosis (DTB) in Human Immune Deficiency Virus (HIV) Infection

Thakur¹,

Iqbal²,

Schezan³

2019

IJMEDPH

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Background: We evaluated the clinical profile of HIV positive patients freshly diagnosed with Disseminated Tuberculosis (DTB) and assessed their response to Anti-tuberculosis treatment (ATT). Aim: To describe various clinical, radiological and pathological parameters encountered in patients of Disseminated Tuberculosis having an HIV co-infection and assessing the response to standard ATT. Settings and Design: This study is a descriptive study. Materials and Methods: We conducted a study on 54 patients of disseminated TB with HIV coinfection who were already on Anti-retroviral therapy. Assessment was focused on mode of diagnosis and distribution of organ involvement. Four months of HRZE and two months of HRE were prescribed as the standard ATT. Effect of this treatment was observed on change in weight, CD 4+ counts and HIV RNA viral loads. Statistical analysis used: Wilcoxon Sign Rank Test for assessing response to ATT. Results: This study included 54 patients. The lymphatic system was the most commonly involved organ system (64.81%) and other organs involved were the liver (55.56%), the lungs (46.3%), the pleurae (12.96%), the meninges (5.54%) and the bone marrow (3.71%). Median weight at baseline was 53 kg (IQR, 49-58) and after six months of standard ATT was 62 kg (IQR, 58-67) (p<0.001). Median CD 4+ count at baseline was 107.5 cells /mm 3 (IQR, 51.5-150.75) and after six months of standard ATT was 246 cells /mm 3 (IQR, 184-335.75) (p<0.001). Median HIV RNA viral load at baseline was 2,83,575 copies/mL (IQR, 1,78,376.25-3,83,370) and after six months of standard ATT was 19,916.5 copies/mL (14,376.25-28,622.5) (p<0.001). Conclusion: DTB in HIV positive patients has a variety of clinical manifestations which should be incorporated in the clinical decision making and change in weight, CD 4+ count and HIV RNA viral load is a reliable indicator of therapeutic response in such cases.

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Section: Discussionmentioning

confidence: 53%

Clinical Profile of Patients with Disseminated Tuberculosis (DTB) in Human Immune Deficiency Virus (HIV) Infection

Thakur¹,

Iqbal²,

Schezan³

2019

IJMEDPH

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“…In this situation, the people in Lh would be more protected than people in Rh. However, if this were the case, we would observe many TB cases with high CD4 cell count that was contradicted by [ 30 , 44 ] that showed that about 90% of co-infected patients have CD4 cell count lower than 400 cells/μl and the risk of TB increases exponentially with the decline of CD4.…”

Section: Discussionmentioning

confidence: 82%

“…We have to emphasize that if people in Rh are more protected than people in Lh does require further investigation and verification with a different model and data set that at least includes information about CD4 cell count and HIV progression. Several papers [ 30 , 43 , 44 ] indicate that the risk of TB increase after CD4 cell counts starts to decline. Therefore, modeling for a short period of HIV infection in this paper overestimates the TB risk of people in Lh.…”

Section: Discussionmentioning

confidence: 99%

Modeling tuberculosis dynamics with the presence of hyper-susceptible individuals for Ho Chi Minh City from 1996 to 2015

et al. 2018

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BackgroundThe depletion of CD4 cell is the underlying reason for TB hyper-susceptibility among people with HIV. Consequently, the trend of TB dynamics is usually hidden by the HIV outbreak.MethodsHere, we aim to evaluate the trend of TB dynamics quantitatively by a simple mathematical model using the known prevalence of hyper-susceptible individuals in the population. In order to estimate the parameters governing transmission we fit this model in a maximum likelihood framework to both reported TB cases and data from samples tested with Interferon Gamma Assay from Ho Chi Minh City - a city with high TB transmission and strong synchronization between HIV/AIDS and TB dynamics.ResultsOur results show that TB transmission in HCMC has been declining among people without HIV; we estimate a 18% (95% CI: 9–25%) decline in the transmission parameter between 1996 and 2015. Furthermore, we show that co-infected patients have limited contribution to the transmission process. For hyper-susceptible individuals, our model suggests that the risk of a new active TB infection occurring is significantly higher than the risk of relapsed active TB, while this is not the case for people without hyper-susceptibility.ConclusionsThe increase of TB notifications in Ho Chi Minh City from 1996 to 2008 is evitable when, as occurred, the number of hyper-susceptible individuals increased faster than the decrease of TB transmission rate. The sharp decrease in TB notifications observed in this city from 2008 to 2015 is the combined result of the decrease of TB transmission rate and the decrease of hyper-susceptible individuals in the population. For hyper-susceptible individuals, we propose that the reason for the reduced relapsed active TB risk is HIV treatment delay. According to HIV treatment guidelines issued by Vietnam’s Ministry of Health, hyper-susceptible individuals usually have to wait until their CD4 cell count falls under 350 cells/μl to start ART. Once patients begin ART, they will remain on ART for the rest of their life and thus have greater protection against relapses of TB. We therefore hypothesize that the delay in using ART imposes considerable TB burden on HCMC despite the declining transmission process.Electronic supplementary materialThe online version of this article (10.1186/s12879-018-3383-3) contains supplementary material, which is available to authorized users.

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“…High viral load increased disease progression. The results of multivariate analysis showed that patients with CD4 levels less than 500 cells / mm 3 were at risk of being infected with 3,141 times compared to patients with CD4 levels more than 500 24 .…”

Section: Discussionmentioning

confidence: 97%

Predictors of Tuberculosis in HIV Patients in the Clinic Voluntary Counseling and Testing in Medan City

Lubis

Jemadi

Utama

et al. 2019

Preprint

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Background: The incidence of tuberculosis in HIV patients (TB-HIV) w as estimated at 126 per 100,000 in the world. The number of HIV infected patients in Indonesia around 190,000 to 400,00 0 and the prevalence of TB-HIV is 5%. Data TB-HIV still increase s and they are un aware of that until a late stage. Understanding the risk factors of people with TB-HIV co-infection is important to know. This study aims to know the predictors of TB-HIV patients in the clinic voluntary counseling and testing (VCT) in Medan city. Methods: This is a case-control study. The case is TB-HIV patients (aged > 20 years) seen at clinic VCT Medan in 2016. Control is HIV patients without TB (aged > 20 years) seen in the same clinic VCT. The number of cases was 120 and the number of control 120. Data were collected from the medical record. Data were analyzed using the chi-square test in SPSS software. Results: The t otal was 240 patients. The majority were in the age group 31-40 years old (52.9%), male (75.8%), married (71.7%), had tertiary education (85.4%), had employment (89.2%) . Significant factors were CD4 < 500 cells/ml (OR 3.92; 95% CI 2.13-7.22), BMI < 18.5 kg/m2 (OR 5.79; 95% CI 3.25-10.21), had history of TB family (OR 7.9; 95% CI 3.67-18.18), adherence ARV (OR 1.35; 95% CI 1.02-1.79). Conclusions: The predictors of incidence TB-HIV co-infection was low CD4, low BMI, and had a family history of TB. Pay the attention for the nutritional status of TB-HIV patients and provide appropriate nutritional intake needs and adherence ARV.

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CD4 count and tuberculosis risk in HIV-positive adults not on ART: a systematic review and meta-analysis

Cited by 48 publications

References 25 publications

Clinical Profile of Patients with Disseminated Tuberculosis (DTB) in Human Immune Deficiency Virus (HIV) Infection

Clinical Profile of Patients with Disseminated Tuberculosis (DTB) in Human Immune Deficiency Virus (HIV) Infection

Modeling tuberculosis dynamics with the presence of hyper-susceptible individuals for Ho Chi Minh City from 1996 to 2015

Predictors of Tuberculosis in HIV Patients in the Clinic Voluntary Counseling and Testing in Medan City

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