Incomplete immunological recovery following anti-tuberculosis.
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Date
2009-05
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Abstract
Background & objectives: Mycobacterium tuberculosis infection has been shown to result in increased
HIV replication and disease progression in HIV-infected individuals through increased immune
activation. The objective of this study was to correlate plasma levels of immune activation markers with
the presence of tuberculosis (TB) in HIV-infected and uninfected individuals, and to study the changes
following anti-tuberculosis treatment.
Methods: Plasma markers of immune activation - neopterin, beta-2-microglobulin (β2M) and soluble
tumour necrosis factor alpha receptor type I (sTNFα-RI) were measured by ELISA in 42 HIV positive
TB patients (HIV+TB+) undergoing a six-month course of TB chemotherapy. Thirty seven HIV+ persons
without active TB, 38 TB patients without HIV infection, and 62 healthy volunteers served as controls.
Results: Plasma levels of all three markers were elevated in HIV+ individuals, more so in those with
active TB. When HIV+ individuals were further categorized based on CD4+ T cell counts, HIV+TB+
patients with CD4+ T cells counts < 200 cells/μl were found to have the highest levels at baseline with a
steep fall in neopterin and sTNFα-RI during treatment, but in most instances the levels did not drop to
normal. β2M levels remained persistently high despite completing TB treatment.
Interpretation & conclusions: The fi ndings of the study suggest that both HIV and TB act synergistically
to activate the host immune system. Although ATT was effective in clearing M. tuberculosis infection, a
high proportion of HIV+ TB patients continued to have levels well above the normal range, indicating
that underlying immune activation persists despite TB treatment. None of the markers were specific
enough to be used to assess cure of TB.
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Keywords
Anti-tuberculosis treatment, HIV-1, immune activation, Mycobacterium tuberculosis, neopterin, sTNFα-RI, β-2-microglobulin
Citation
Hanna L E, Nayak Kaustuv, Subramanyam Sudha, Venkatesan Perumal, Narayanan P R, Swaminathan Soumya. Incomplete immunological recovery following anti-tuberculosis. Indian Journal of Medical Research. 2009 May; 129(5): 548-554.