Background: Human immunodeficiency virus (HIV) infection is usually complicated by high rates of tuberculosis\n(TB) co-infection. Impaired immune response has been reported during HIV/TB co-infection and may have\nsignificant effect on anti-retroviral therapy (ART). TB/HIV co - infection is a major public health problem in Ethiopia.\nTherefore, the aim of the study was to assess the effect of TB incidence on immunological response of HIV patients\nduring ART.\nMethods: A retrospective follow-up study was conducted among adult HIV patients who started ART at the University\nof Gondar Hospital. Changes in CD4+ T - lymphocyte count and incident TB episodes occurring during 42 months of\nfollow up on ART were assessed. Life table was used to estimate the cumulative immunologic failure. Kaplan-Meier\ncurve was used to compare survival curves between the different categories. Cox-proportional hazard model was\nemployed to examine predictors of immunological failure.\nResults: Among 400 HIV patients, 89(22.2%) were found to have immunological failure with a rate of 8.5 per 100\nperson-years (PY) of follow-up. Incident TB developed in 26(6.5%) of patients, with an incidence rate of 2.2 cases per\n100 PY. The immunological failure rate was high (20.1/100PY) at the first year of treatment. At multivariate analysis, Cox\nregression analysis showed that baseline CD4+ T - cell count <100 cells/mm3 (adjusted hazard ratio (AHR) 1.8; 95%CI:\n1.10 - 2.92, p = 0.023) and being male sex (AHR 1.6; 95%CI: 1.01 - 2.68, p = 0.046) were found to be significant predictors\nof immunological failure. There was borderline significant association with incident TB (AHR 2.2; 95%CI: 0.94 - 5.09,\np = 0.06). The risk of immunological failure was significantly higher (38.5%) among those with incident TB compared\nwith TB - free (21.1%) (Log rank p = 0.036).\nConclusions: High incidence of immunological failure occurred within the first year of initiating ART. The proportions\nof patients with impaired immune restoration were higher among patients with incident TB. Lower baseline CD4+\nT - cells count of <100 cells/mm3 and being male sex were significant predictors of immunological failure. The result\nhighlighted the beneficial effects of earlier initiation of ART on CD4+ T - cell count recovery.
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