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Inventi Impact: Preventive & Social Medicines

Articles

  • Inventi:had/81/14
    VIROLOGIC AND IMMUNOLOGIC OUTCOME OF HAART IN HUMAN IMMUNODEFICIENCY VIRUS (HIV)-1 INFECTED PATIENTS WITH AND WITHOUT TUBERCULOSIS (TB) AND LATENT TB INFECTION (LTBI) IN ADDIS ABABA, ETHIOPIA
    31-Dec-2013 Research 2014 : January - March
    Desta Kassa, Gebremedhin Gebremichael, Yodit Alemayehu, Dawit Wolday, Tsehaynesh Messele, Debbie van\r\nBaarle

    Background: HIV/TB coinfection remains a major challenge even after the initiation of HAART. Little is known\r\nabout Mycobacterium tuberculosis (Mtb) specific immune restoration in relation to immunologic and virologic\r\noutcomes after long-term HAART during co-infections with latent and active TB.\r\nMethods: A total of 232 adults, including 59 HIV patients with clinical TB (HIV TB), 125 HIV patients without\r\nclinical TB (HIV TB-), 13 HIV negative active TB patients (HIV-TB), and 10 HIV negative Tuberculin Skin TST positive\r\n(HIV-TST), and 25 HIV-TST- individuals were recruited. HAART was initiated in 113 HIV patients (28 TB and\r\n85 TB-), and anti-TB treatment for all TB cases. CD4 T-cell count, HIV RNA load, and IFN-? responses to ESAT-6/\r\nCFP-10 were measured at baseline, 6 months (M6), 18 months (M18) and 24 months (M24) after HAART initiation.\r\nResults: The majority of HIV TB- (70%, 81%, 84%) as well as HIV TB patients (60%, 77%, 80%) had virologic\r\nsuccess (HIV RNA < 50 copies/ml) by M6, M18 and M24, respectively. HAART also significantly increased CD4 T-cell\r\ncounts at 2 years in HIV TB (from 110.3 to 289.9 cells/�µl), HIV TB- patients (197.8 to 332.3 cells/�µl), HIV TST-\r\n(199 to 347 cells/�µl) and HIV TST individuals (195 to 319 cells/�µl). Overall, there was no significant difference in\r\nthe percentage of patients that achieved virologic success and in total CD4 counts increased between HIV\r\npatients with and without TB or LTBI. The Mtb specific IFN-? response at baseline was significantly lower in HIV TB\r\n (3.6 pg/ml) compared to HIV-TB patients (34.4 pg/ml) and HIV TST (46.3 pg/ml) individuals; and in HIV-TB \r\npatients compared to HIV-TST individuals (491.2 pg/ml). By M18 on HAART, the IFN-? response remained impaired\r\nin HIV TB patients (18.1 pg/ml) while it normalized in HIV TST individuals (from 46.3 to 414.2 pg/ml).\r\nConclusions: Our data show that clinical and latent TB infections do not influence virologic and immunologic\r\noutcomes of ART in HIV patients. Despite this, HAART was unable to restore optimal TB responsiveness as measured\r\nby Mtb specific IFN-? response in HIV/TB patients. Improvement of Mtb-specific immune restoration should be the\r\nfocus of future therapeutic strategies

    How to Cite this Article
    CC Compliant Citation: Kassa et al.: Virologic and immunologic outcome of HAART in Human Immunodeficiency Virus (HIV)-1 infected\r\npatients with and without tuberculosis (TB) and latent TB infection (LTBI) in Addis Ababa, Ethiopia. AIDS Research and Therapy 2013\r\n10:18, doi:10.1186/1742-6405-10-18.
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