Effects of Tuberculosis on the Kinetics of CD4⁺T Cell Count Among HIV-Infected Patients Who Initiated Antiretroviral Therapy Early After Tuberculosis Treatment

Abstract

The effects of tuberculosis (TB) on the kinetics of CD4(+) T cells among HIV-infected individuals with early combination antiretroviral therapy (cART) after TB therapy initiation are poorly characterized. We conducted a case-control study with 15 HIV-TB-coinfected patients who initiated TB treatment and early cART, and 30 controls without TB who had similar CD4(+) T cell counts and viral loads at the time of starting cART. We compared the rate of CD4(+) T cell increase for 5 years after cART. The time to CD4(+) T cell increase >250 cells/mm(3) was significantly slower in HIV-TB-coinfected patients (p=0.015, by log rank test). HIV-TB-coinfected patients had significantly lower median CD4(+) T cell counts at 5 years after cART (p=0.048). The difference in CD4(+) T cell increase was observed only during the first 6 months after cART initiation (p=0.002). These data suggest that TB slows the rate of CD4(+) T cell recovery at an early period after cART. The effects of TB on the long-term immunity of HIV-infected patients should be further evaluated.

The Prognosis for Delayed Immune Recovery in HIV-Infected Children might be Associated with Pre-cART CD4 + T cell Count Irrespective of Co-Infection with Tuberculosis

“…Another study from sub-Saharan Africa has also reported no difference in the immune recovery of HIV-infected individuals with or without TB co-infection after starting cART 38 . These ndings contrast with reports from high-income settings, which have linked the failure of immune recovery among cART-treated individuals to the levels of viral suppression 39,40 . These divergent results are probably affected by additional variables, such as the quality and accessibility of public health systems, genetic diversity, degrees of virological suppression, the timing of treatment initiation, and the speci c type of cART provided to individuals across various cohort settings.…”

Immunological and virological discordance among people living with HIV on highly active antiretroviral therapy in Tigray, Northern Ethiopia

“…Our study also showed significant difference among TB co-infected individuals ( p = 0.016). This finding is also in line with a study conducted in South Korea [ 23 ]. This might be explained as TB infection impairs cellular immune responses through M. tuberculosis induced apoptosis of CD4+ cells which subsequently lead to depletion of CD4+ cells and results in poor immunological recovery despite viral suppression [ 24 ].…”

Increased Prevalence of Liver Fibrosis and HIV Viremia among Patients with HIV, HBV, and Tuberculosis in Botswana

“…In light of this, cHIV/HBV was previously shown to result in slow CD4+ T-cell recovery in these patients compared to PLWHIV only [ 9 , 42 ]. TB also results in slow CD4+ T-cell recovery even after ART initiation [ 43 , 44 , 45 ]. In one South Africa cohort of 15,646 adults, there was no difference in immune restoration between participants with cHIV/TB and those without TB after ART initiation [ 46 ].…”