Age, sex, and nutritional status modify the CD4+ T-cell recovery rate in HIV–tuberculosis co-infected patients on combination antiretroviral therapy

Abstract

Background We examined baseline age and combination antiretroviral therapy (cART) as determinants of CD4+T-cell recovery during six months of tuberculosis (TB) therapy with/without cART. We determined whether this association was modified by patient sex and nutritional status. Methods This longitudinal analysis included 208 immune-competent, non-pregnant, ART-naive HIV-positive patients from Uganda with a first episode of pulmonary TB. CD4+T-cell count was measured using flow cytometry. Age was defined as ≤24, 25–29, 30–34, 35–39 vs. ≥ 40 years. Nutritional status was defined as normal (>18.5kg/m2) vs. underweight (≤18.5kg/m2) using body mass index (BMI). Multivariate random-effects linear mixed models were fitted to estimate differences in CD4+T-cell recovery in relation to specified determinants. Results cART was associated with a monthly rise of 15.7 cells/μL (p<0.001). Overall, age was not associated with CD4+T-cell recovery during TB therapy (p=0.655). However, among patients on cART, age-associated CD4+T-cell recovery rate varied by sex and nutritional status such that age <40 vs. ≥ 40 years predicted superior absolute CD4+T-cell recovery among females (p=0.006) and among patients with BMI≥18.5kg/m2 (p<0.001). Conclusions TB infected HIV-positive patients ≥ 40 years have a slower rate of immune restoration given cART-particularly if BMI>18.5kg/m2 or female. They may benefit from increased monitoring and nutritional support during cART.

Vitamin-D deficiency impairs CD4+T-cell count recovery rate in HIV-positive adults on highly active antiretroviral therapy: A longitudinal study

“…The observations that VDD was associated with more dysregulation of absolute CD4+T-cell recovery in younger patients, and that the absolute amount and speed of improvement differed by pre-treatment nutritional status are similar to prior reports of age and BMI-related differences in immune recovery among HIV and tuberculosis co-infected Ugandan adults [23]. These age and nutritional status interactions in VDD-/VDI-associated lower CD4+T-cell recovery suggests that previously reported age-related immune recovery advantage in younger HIV-infected adults [24] maybe compromised by malnutrition [25,26].…”

“…Baseline CD4+T-cell was included in the outcome matrix; no assumption was made regarding the relationship between vitamin-D status and CD4+T-cell count at baseline given our observational study design [23]. An unstructured covariance matrix was assumed to account for non-independence of repeated CD4+T-cell counts within individuals.…”

Socio-demographic and Clinical Variables associated with the variation of CD4 Cell Count and Body Mass Index (BMI) for HIV Positive adults receiving HAART, a joint longitudinal data analysis

“…Retention and close flow ups in medication care had also direct and significant effect on BMI which means patients which closely follow their prescribed medication given by the health staff had good adherence competence and this further leads to great BMI. This result agreed with previous researches [22,23]. Retention in medication care and adherence competence had direct and significant effect on the variable of interest (CD4 cell count change) which has similar argument with previous researches [21,22].…”

“…This result agreed with previous researches [22,23]. Retention in medication care and adherence competence had direct and significant effect on the variable of interest (CD4 cell count change) which has similar argument with previous researches [21,22]. Retention in HIV medication care is a crucial activity for achieving optimal CD4 cell count and not to be under weight for patients following their treatment [24].…”

The impact of nutritional status and nutrition supplementation on outcomes along the HIV treatment cascade in the resource-limited setting

“…Overall, nutritional status was not associated with CD4 recovery. Underweight patients (BMI 18.5 kg/m 2 ) gained more CD4 cells per month when compared with individuals who were normal weight at enrollment [6].…”